Hello everyone,
We are currently dealing with a sesamoid issue for the last 6 months. My daughter's injury came to light at the state cup soccer tournament. My daughter is a tough cookie (12 yrs old at the time). Her coach eventually had to go on the field and help her off since she could not take the pain any longer. The on duty paramdic person checked her foot, wrapped it and told her to ice it. Said if the pai wasn't bad she could play the next game, needless to say my daughter played over 1/2 the game in horrible pain, but her love for the game kepted her on the field until she couldn't handle it any longer. We went to her sports therapist and his concern was that it was a fractured sesamoid. We went to the dr. and got X-rays, it came back that she didn't have a fracture. We went back to the sports therapist a couple of times various treatments to help her recover. After a handful of appointments they asked for a copy of her Xray, we brought it the following appointment, upon his receive it looked like a fracture. Lovely! So luckily for us we had a walking boot and we put my daughter in it immediately, we went back to teh dr. office and was the min dr., he conclusion was it was a fracture. We saw the sport therapist 3 times a week for almost 8 weeks for laser, some vacuum boot and pulse treatment, we also had 1 more set of X-rays done. It looked like all the suppliments and extra items we paid for out of pocket were helping. She got released and went back to soccer immediately.
Needless to say the pain wasn't as bad but we went back to the dr. after a month since the pain was getting back up to a 7/8 on a 1-10 scale and she was only able to play maybe 10 minutes at a time. The dr. said for her to take it easy and not push herself so much.
A month later.... We received a recommendation to a good podiatrist, we went to see him and he took X-rays of her left foot and after reviewing them decided to take a picture of the right foot for comparision. My daughter has bipartites, the wrong sesamoid was being treated, it was the lateral sesamoid that was irritated. Most of the treatment we did was not helpful besides being in a boot and not being physically active. We immeidately took her out of soccer and PE again for a month. He said not to put her back in the boot, no walking barefoot (even at home), no flip flops, no casual no flexible shoes either. We got Superfeet insoles and went straight to an athletic shoe store for a good apir of shoes. We looked for a stiff supportive shoe, we went through a ton of shoes to see how sturdy the forefoot was, looking for the least flexible. We finally found a pair, the podiatrist also okayed her to wear Doc Martins but that was after 4 weeks in athletic shoes. Eventually he okayed her to slowly return to soccer.
(When we did see the podiatrist we had 3 options, surgery was not 1 of them. #1 try the insoles and supportive shoes with rest to see if that would help. #2 Cortisone shots (not doing that to a 13 yr. old) #3 orthodics. He did say sometiems the pain doesn't go away and some people have learned to live with the pain, in reference to people that still play sports.
After she was release we went to a high end soccer store and tried on about 8 pairs of cleats looking for something that wouldn't irritate the seasmoid with the cleat location or too much flexibility, making sure her insoles would fit comfortably. We have followed his return directions in regards to her returning slowly. She practices 3 times a week, there is still pain but now it's not immediately, she's starting to feel it toward the end of practice and if she does too much cutting in she can feel the pain start faster. Her coach says she's at about 70% recovery and after soccer practice her pain level on her foot is at about a 5 on a scale 1-10. She always brings her authletic shoes with the support to switch into if needed.
My hopes are that eventually it will go away, 6 months for a 13 year old girl is forever! This weekend she will be back on the field for a tournament, cross your fingers! We will give this a little more time, then most likely go back to the podiatrist and see about orthodics, if we can't seem to find something else to help relieve the pain, such as adding additional insoles and wraps.
(Sorry for any typos, didn't have much time to type this.. )
K
Hi - what happened with your daughter? My 12 year old son was recently diagnosed with sesamoiditis 4 weeks ago. He plays soccer year round. Probably an overuse issue. They casted him for two, now a boot for the last two with PT. He is very discouraged says that the pain hasn't gotten any better at all. The PT at Children's assures us that this WILL heal, but that you have to be very patient. We take ibuprofen for anti-inflammatory and ice as much as he can. From what I have read it seems that this injury occurs in folks with a high pain tolerance and with a stronger than normal ability to concentrate and thus avoid the pain. This doesn't help in treatment. I'm thinking the solution is rest rest rest, but that is hard for most people, especially an on the go 12 year old boy.
You may not want to hear this but after all we went through with this, taking the most conservative treatment is what seems to work with this injury especially in those so young. It felt like the end of the world after a year of being misdiagnosed so many times to finally just say "enough" and just get completely off of it and let the poor thing heal. 6 weeks in crutches with non-weightbearing, 6 weeks walking boot, 6 weeks CUSTOM orthotics to float the sesamoid. It took many weeks for the pain to go away and we never thought it would but three months after going on crutches, she finally was pain free and slowly worked back in to gymnastics. It killed her to miss that much, and she kept conditioning through it all so that when she went back, she was still very conditioned. I worried about her being behind when she got back. But it was all worth it. She did not start running until that sesamoid was pain free and healed on the xray. Then I kept waiting for her to say that t hurt a little or a lot but beyond it being a bit sore the first two days back, nothing. Then within a couple of weeks she doing back tucks and back handsprings on the balance beam with no pain at all. Nothing. Completely healed. I feel like if we skipped any of those treatment steps and went back to early, we'd still be dealing with it. I see that a lot at the gym...partial treatment for injuries so that they can stay active but end up costing more in the long run with re-injury. I remember at the beginning of trying to treat this I thought that was no way I could have my daughter out for 3 whole months but it ended up being a little longer but totally worth it. However, since she did beat it to heck for a solid year and did her whole competition season on it, there is room to delay the start of treatment if she can handle it.
Thank you for your reply. Who did you find in the end that helped you? Was it a Sports Ortho or a Podiatrist? How did you find the right doctor. And, I'm curious, did your daughter have a bipartide sesamoid? My son does. We still haven't gotten a final answer on whether or not his sesamoid is fractured or he has sesamoiditis. Also, was your daughter's toe ever swollen? His is not. We are getting an MRI this week to try to get more information THANK YOU FOR YOUR RESPONSE!
Hi.
I know it has been a long time since your post about your sesamoids. I am in the same situation. Looks like both sesamoids are fractured and the healing process is painfully slow. very little activity and mild persistent pain.
Did you ever get the surgery?
Thanks
-Dave
Sorry for the late response! What helped me in the end? A combo of both. The RIGHT Sports Ortho...a foot specialist ortho, and Dr. Blake on Dr. Blake's Healing Sole website. And we found the right doc by scheduling several 2nd opinion visits with various foot specialist orthos after a lot of research. We knew we had the right one when he took the time to listen to everything, asked questions, and looked at all of the imagery with a fine toothed comb. Not having a bipartite was the problem in the first place...any doc with any xray assumed it was bipartite, not a fracture. Looking back at the xrays over the months, obviously it was fractured based on the pain and symptoms.
My daughter's toe joint was very swollen, hard and red. But, that was after many months of pounding gymnastics on it. What did the MRI reveal?
The pain in my toe joint was the most noticeable thing, and has really caused me to cut back on exercise. When that hasn't done the trick and I'm in much, much worse shape than I was, I finally went to an orthopedist. She was most worried about my S.I. joint on that same side. Prescribed physical therapy and he found more problems. I had felt for probably 20 years like my left hip was kind of crammed in the socket, and then it had started clicking quite a bit. Both docs were thinking I'd need arthroscopic or something if they couldn't get the clicking to stop. I had also been rolling my left foot out to reduce pressure in that hip, and had I guess a sprain I didn't realize-when they probed the tendon outside and below the ankle, wow, it hurt. Still have a pinching in my back that I guess I'd been rotating away from-they say it may be a disc bulge. All of this! But my toe still hurts! I think the moral of my story is don't ignore the toe, or the hip, because you'll end up with four times the trouble.
Well, I feel really sad when I hear that such young people get this problem. At least I'm not a kid, but I'd expected to have at least 10-12 more good years ahead of me at this point in life. 8 months ago I was an active 50-year old trail runner, hiker, mountaineer, and backpacker. People were amazed by my energy. Not anymore. I've steadily cut back on all physical activity until all I can do is basically make it to the restroom and back, with pain. 3 weeks in a boot, a month on crutches and a knee scooter, cortisone shot, Aleve, ice, expensive custom orthotics, and I'm just in constant pain. The podiatrist told me to get off of the knee scooter because my feet and legs could atrophy. The minute I stepped back on the ground, it all swelled right back up. No idea what to do--and I guess I can't get disability. It sounds like a few people got better from rest? Anyone have any luck with cortisone shots? BTW-- I also got the orthotics for another condition and subsequently developed the sesamoiditis while "resting" my feet from the other condition--anyone had negative experiences with custom orthotics? I'm thinking about jettisoning them.
Agreed, very sad to read the stories of younger kids diagnosed with this injury that seems to halt all forms of a happy active lifestyle.im 29 and have had my left foot with sesamoiditis for now 11 months and has been the worst injury ive had in my life, id much rather break my leg that have this silly injury.however i can now say that i am now back to 70% of original health but can feel pain from running on hard surfaces, surfing and lots of fitness related exercises (skipping, jumping etc)ive not gone to any foot specialist after reading lots of negative outcomes, avoided cortisone shots but did lots of rest, ice, shoe changes, softer insoles in shoes etc.i remember first getting foot problems from over walking on a treadmill wearing a pair of Five Finger shoes that have zero cushioning, picture balls of feet slapping on tread mat for hrs on end.
anyways, now im still wearing semi minimalist shoes (ASICS GEL-Lyte33 2) that have lots of cushioning with a semi flexible sole that allow me to run again with minimal pain.the real bummer is that i have to now size up another half size when buying shoes and need a wider toebox shoe as any slight upper foot restrictions promote pain and claustrophobic feelings in my foot ? weird muchwell hope u get better Mr Trail Runner as your life sounds like it was def in motion and i know how hard it is to just STOP everything, its kinda depressing hey. chin up, God speed in your recovery.
I am very leery of minimalist shoes since that's when my feet problems really started. For people with high arches, I suspect lots of support is better since the problem has to do with the hypermobility of the joint. So, now I have been in a camwalker for 8 weeks. Not a lot of improvement. However, I did learn a few things: my first podiatrist was very uncommunicative and prescribed physical therapy. The physical therapist had little experience with sesamoiditis and had me doing exercises intended for plantar fasciitis, which apparently negated any benefit I might have gotten from the camwalker (do not flex the irritated toe joint!) I learned this from the second podiatrist, who was unaware I was doing exercises all through "the boot". So far, acupuncture is providing some pain relief. I may go into a full plaster cast soon to see if complete immobilization helps. The best I can do is weights at the gym now, and light bike-riding on flat ground. Best we can do is keep trying, I guess. Maybe PRP would help this condition?
The only thing that worked for me was what this guy said to do on one site after almost 3 years of having sesamoiditis. It took about a month to go away after that. The book is a little long but has great information.
***this post is edited by moderator *** *** web addresses not allowed*** Please read our Terms of Use
can you tell us the name of the book so we can google it, web addresses seem to be looked down upon here
There is a serious lack of information out there about how to deal with sesamoid injuries. Delayed and misdiagnosis are rampant. Sometimes it seems like our doctors are just guessing about how to solve our problem. No one seems to be able to say how long recovery will take, or even if a full recovery is possible. Some doctors even suggest that pain while walking might be the new normal for the rest of a person's life!?!
In contrast, if you sprain your ankle, or damage your achilles tendon, doctors are more consistent. These injuries are much more common than sesamoiditis. There are well established guidelines for treatment of ankle sprains and achilles tendonitis.
For comparison, a bad ankle sprain, which involves a ligament, will put you out of comission for 6-8 weeks. Achilles tendonitis could put you out for 3 to 6 months. Tendons take forever to heal. So why are patients sometimes told they can get back to their activities after only two, four, or six weeks for sesamoiditis?
Sesamoiditis is a problem with tendons. There are two different types of tendon injuries, and it's really important to know which one you have, since recovery can be very different for each.
Tendinitis (as the “itis” suffix suggests) involves tendon inflammation. This is what most of us think we have when we are told we have "sesamoiditis".
Tendinosis describes tendon degeneration without inflammation.
Both fall under the more general umbrella diagnosis of “tendinopathy,” but nearly all cases of tennis elbow, sore Achilles’ tendons, jumper’s knee, shoulder pain and foot problems stem from tendinosis. Instances of tendinitis, on the other hand, are relatively rare.
An article called "Tendon Trouble" from experiencelife explains this difference, and it's implications, really well:
"Tendinitis is caused by the rapid convergence of white blood cells on an injured tendon, provoking an inflammatory reaction. Normal tendon strands lie side by side, but when suffering from tendinitis, they swell and bump against each other. The injured area is warm to the touch and can be quite painful.
Luckily, with a little ice and rest, tendinitis takes as little as two weeks to heal, says Scott Rodeo, MD, an orthopedic surgeon and clinician-scientist at The Hospital for Special Surgery in New York, as well as a team doctor for the 2007 Super Bowl champion New York Giants.
Tendinosis, on the other hand, stems from chronic overuse rather than a single acute event. “With tendinosis, there’s an abnormal collagen or protein buildup — the tendon’s microfibers start to resemble sticky, overcooked spaghetti,” says Karim Khan, MD, PhD, assistant professor of family medicine and human kinetics at the University of British Columbia in Vancouver and coauthor of Clinical Sports Medicine (McGraw-Hill, 2006).
Damage occurs at a microscopic level long before symptoms of pain, tightness and soreness appear. As with tendinitis, you might feel anything from a slight twinge to a jabbing pain.
Tendinosis usually occurs because you have not rested enough between workouts that require heavy or stressful loading to the affected area. But, because researchers have ˙ not specifically identified an optimal rest period to prevent the condition, many fitness experts simply recommend that you follow a periodized program, with built-in deloading phases, to help prevent such overuse injuries. (For more on periodization, see “Chart a Course to Fitness” in the December 2007 archives.) Cross-training can also help you avoid overusing a particular area.
Unlike tendinitis, tendinosis often requires at least three to six months for recovery. “It’s not realistic to think you can heal in, say, six weeks, because it probably took a lot longer than that to reach the point of pain,” says Bryan Chung, MD, PhD, founder of the blog Evidence-Based Fitness.
Some physicians even stretch that recovery period to nine months or more. Tendinosis takes a considerable amount of time to heal because of limited blood flow to tendons, and because it can take 100 days for your body to reestablish strong collagen, which repairs damage."
Most cases of Sesamoiditis probably involve both tendonitis and tendonosis. The problem is that we are only treating the tendonitis - the inflammation and acute pain.
If you have tendon damage, you need 3 to 6 months of rest. For the sesamoid tendons, which are located in a part of the body with generally poor blood supply anyway, you need even more rest. Nine months recovery time involving no stress to the tendons would be an appropriate suggestion. That would mean not doing anything that gives you any pain (acute or delayed) in the ball of the foot. If you have pain, even hours later, from an activity, stop doing it. Most of us aren't given that advice.
Once that period of rest has passed, slowing ramping up activity, following the rule that pain is bad, and no pain is good, should allow a full recovery for sesamoiditis.
One note about ice. Ice is good for tendonitis (inflammation of the tendon). A chronic case of sesamoiditis will not be helped by ice. Ice may reduce the pain, making you think it's okay to run around as long as you ice afterwards. Ice is good if you have inflammation during the first few days after an acute injury. After a few days, it's better to switch to heat. If you feel pain with heat, it's a good sign that you are not healed. Alternating hot and cold (contrast baths) will help during this phase.
To prevent future problems with the sesamoids, look for shoes that allow a natural toe splay. your foot was meant to look like a triangle, with the end of your toes being the widest part of your foot. Most shoes, especially soccer shoes, dress shoes, and nearly all shoes for women, squish the toes. This can cause the sesamoids to shift out of their natural groves. For a good video demonstration of this, watch the YouTube video: "Natural Foot Wisdom with Podiatrist Dr. Ray McClanahan".
***this post is edited by moderator *** *** web addresses not allowed*** Please read our Terms of Use