Sesamoiditis/Sesamoid Fractures

[kvargas]

I have had years of foot problems. Currently, I face the possibility of sesamoidectomy, which i want avoid as much as possible. I'm 23, and have had intense sesamoiditis for almost 2 years. I have chronic pain, I pretty much limp constantly, but I also get shooters that send sharp pain up my toe that stick around for a couple minutes or make the chronic pain for the rest of the day. A year ago exactly I had a steroid injection to alleviate the pain and was told to get custom orthotics for arch support, which i did. I also tried icing and regular usage of nsaids for about a month but didn't feel any difference. Due to insurance changes I saw another podiatrist 3 months ago who said I have some biomechanical issues like a hyper mobile big toes so I was casted and got new orthotics with a cutout for the sesamoiditis and to realign my foot. I was also told that the sesamoid that is causing troubles is also bipartite. My podiatrist referred me to physical therapy, so I've been doing that for almost two months with iontophoresis, some ultrasound, and electrical stimulation along with strengthening and stretching exercises along with a year of wearing orthotics with very minimal or no results.

In 2003 I also partially tore my lis-franc ligament twice, however I was told this doesn't effect my current conditions. I've also always had flat feet and started wearing orthotics when I was 13.

Does anyone have any advice? I am an elite rugby athlete and my sesamoiditis just keeps getting worse and doesn't allow me to train fully. I also be starting intense graduate school within a couple months for a couple years where I'll be on my feet constantly so I want to feel better. How long should I do PT for? Should I consider a sesamoidectomy? Should I do another steroid injection? What else can I do?

[henhouse]

I had a sesamoidectomy about 15 years ago and wish I wouldn't have. I too was at my wits end, having tried everything from shoe pads to cortisone. I have been walking a bit weird, sometimes limping, for 15 years, and my condition is significantly worse than before the surgery. For me, adjusting my lifestyle (no more running and jumping, hikes under 3 miles), finding the right shoes (hiking shoes with cushy insides but stiff soles!) and work on strengthening and aligning the rest of me through swimming and yoga have been key. It took years to figure out what I needed to do to take care of this injury and much of what I learned was not found at the doctors office. I still have flare-ups when I have to stay off it extensively and wear the boot. If you can, see an orthopedist instead of a podiatrist, as their training is more well-rounded.

[Dremmie]

I got put in a boot today for an extreme fracture of my medial sesamoid. The other isn't as bad. No way would my doctor even consider a Seamoidectomy. (Orthopedic doctor) These tiny bones help you balance. Without them, you could be screwed. They don't have "implants" from what I understand to replace them. Usually your big toe is fused in an upward fashion so that you can still walk. It will always be higher than the other toes on your foot. Although the pain can be disabling to say the least, I'd think long and hard before I did something so drastic. BTW I've had 3 knee surgeries in the past two years so I understand pain. I've been dealing with semamoiditis fora few years and just thought it was a bruise on the bottom of my foot. When I told my PT about it (For knee recovery) he pressed on my foot and I thought I was going to fly off the table. He insisted that I tell my Doctor. They padded my shoe for 6 weeks before this. So for the next 1-3 months I get this joy. Think long and hard before you do something drastic that you can't redo.

Best wishes