Will sesamoiditis go away or is this forever?

My 11 year old daughter started having foot pain exactly one year ago in right foot. She is (or was) a gymnast and it was competition season so I just assumed she had just bruised it or something. I gave her Motrin daily and talked with her coaches, who seemed to agree with me and just to watch it. I finally took her to ortho in April and he diagnosed sesamoiditis. Fast forward to now- she has had 2 MRIs, physical therapy, 2 casts (1 in the beginning for 2 weeks and the other at Christmas for 6 weeks with crutches and no weight bearing). She wears a bone stimulator 3 hrs every night for bone healing and she has had 2 pairs of custom orthotics made which made the pain worse. They were awful. Her last X-ray definitely showed a small stress fracture on bone which we already knew. She has pretty much worn a walking boot the entire year, except for times of casting. She cannot do gymnastics and hasn't since May.  We are at a loss and not knowing what else to do. I refuse to let them remove the bone and her ortho agrees. I have not read anything good about the surgery. I don't know what else to try but when she tries to walk without the boot she has a lot of pain.  She loves gymnastics and we're thinking she'll never be able to do it again, or any other impact sport. The last X-ray and MRI looked better than the initial ones but still shows stress area. I would love any advice or input on what else to try (inserts, etc)

I'll be watching this post as I can not find much on the internet about young gymnasts with sesamoid problems.

My ten year old is a training level 7 and had problems with the toe for a year before it finally "blew" 7 weeks ago.  MRI showed fractured sesamoid though I feel she probably had a stress fracture there for some time.  She complained about her aching toe for months but all they told me was a sprain, she she toughed through it.

She has been in a boot and non-weightbearing crutches for 4 weeks so far, but I am freaked out by the horror stories I hear about surgery.  I have finally come to the point where I feel I need to see a Foot and Ankle Orthopedic Surgical Specialist to proceed any further. So many doctors have been wrong about it in the last 14 months, I have resolved just to go to the top.

We should stay in touch:)

~Amy

I'll be watching this post as I can not find much on the internet about young gymnasts with sesamoid problems.

My ten year old is a training level 7 and had problems with the toe for a year before it finally "blew" 7 weeks ago. MRI showed fractured sesamoid though I feel she probably had a stress fracture there for some time. She complained about her aching toe for months but all they told me was a sprain, she she toughed through it.

She has been in a boot and non-weightbearing crutches for 4 weeks so far, but I am freaked out by the horror stories I hear about surgery. I have finally come to the point where I feel I need to see a Foot and Ankle Orthopedic Surgical Specialist to proceed any further. So many doctors have been wrong about it in the last 14 months, I have resolved just to go to the top.

We should stay in touch:)

~Amy

@ Amy

I agree~even my daughter's gym coach had never heard of this with any of her other gymnasts. We are at a loss and not sure what else to do. It's been a year and we've tried everything (except or surgery). I do not intend to do surgery at this point~she's only 11! I'm thinking of getting a second opinion, even though I do like her pediatric ortho. I will post as anything changes.

I too was diagnosed with sesamoiditis and a "likely" fracture. I got this by wearing high heels...yes, that is right, wearing high heels. Unfortunately, I worked in a corporate business world and was told to wear heels every day for a specific reason that I won't get into now. After a few weeks me and two of my coworkers started to complain about pain in the balls of our feet. I switched to wearing kitten heels but the pain persisted for about a month before I finally went to the doctor. I went to a podiatrist and after taking x-rays he said he could not get a clear enough image to see if it was indeed fractured (there was a faint line on the x-ray that he believed may have been). He put me in a plastic boot for 6 weeks but it only seemed to make it worse. I called him and he told me it was just my bone healing but when i went in for my checkup he told me that it should not be behaving the way it has been anymore. The ball of my foot was still obviously swollen and I informed him that my big toe was constantly inflamed after only standing for 15 minutes in my boot (I couldn't even wash the dishes without it blowing up so tight I felt like my skin would burst!) He said that was a really bad sign and could mean that the bone is dying, yes DYING. He said one thing common with sesamoiditis is that the blood supply to these bones is very limited so if it does not heal quickly enough the bones will eventually die. The swollen big toe that I was describing was an indicator that the bone was dying (apparently a dead bone appears bright white on an x-ray and mine had gotten whiter since the last visit). He gave me crutches and told me to come back in 3 weeks. No improvement was made during this time so he ordered an MRI. The MRI revealed that I had sesamoiditis on the exterior sesamoid but it was actually my interior sesamoid bone that was likely broken and had the most fluid around it. He then ordered me a bone stimulator which uses ultrasound to speed up the healing. He said this was our last option and that the next step would be removing the bones completely. After only 2 days of use the tightness I had felt constantly for the past 2 months is gone! It still unfortunately have swelling flare-ups so I may still need surgery eventually if it doesn't get any better than this but I am trying to be optimistic about it. Plus, it is now getting to the point where I am so limited in my physical activity (aka. absolutely NONE for the past 3 months now) that I would rather have them removed just to solve the issue forever! the bone stimulator will probably save a lot of you that only have a minor case, and in a much quicker time. It does cost about $2,500 but some insurance companies do cover it. Even if your insurance doesn't cover it (which mine did not), you can still see if you can get financial assistance. They were able to get mine down to just $475, which I believe is well worth it!

Start rowing on an indoor rowing machine.

(Brace your feet if this hurts initially)

 

From my research, removing the bones is a huge mistake and causes more problems than it fixes. Best wishes.

Hello! Last summer, I had a job where I was walking around a lot on my feet, in not very supportive shoes. One day, I came home from work and the balls of my feet were killing me. I took a couple days off, and rested my feet, and they started to gradually get better. Fortunately, the pain did not reach the level that it did that first day, and about a month later I got a new, more sedentary job. My feet were still in the healing process, but they didn't seem so bad, so I just kept wearing the same shoes. I went hiking and dancing and the worst that they felt was mildly annoying. Then about 4 months ago, my feet started feeling really bad, so I finally went in to see a podiatrist. The first one couldn't care less about my feet. The second, just wanted my money. And finally I found a good one who specializes in sports medicine. He got an MRI of my foot and could see a lot of inflamation on the bone of the sesamoid, with a potential fracture (or bipartite sesamoid). For the past 3 months, I have been resting a lot. I've stopped walking everywhere like I used to. And now I've got a boot on my right foot (because it is more painful than the left). The pain is not excruciating, but it definitely inhibits daily activity and I cant walk normal or wear ordinary shoes. The general ball of my foot is very stiff, especially in the morning. The doctor says this is because I was compensating for the sesamoid by putting too much wait on that side of my foot. For 4 months, I was trying to find a shoe that worked with me. I am currently wearing Brooks' adrenaline, and Sanita in narrow. I was very frustrated, bc I had spent a lot of money on shoes trying to find one that worked. I had bought 4 different pairs of Sanita/Dansko shoes (different brand but similar shoe) until I found one that fits which is 2 sizes up from the first shoe I bought and is a narrow width instead of normal. So I guess I have very narrow and long feet. For the past month I have been doing contrast bathing at least once a day (dip feet in ice water for 1 minute, and then soak in warm water for 4 minutes, repeat five times for a total of 20 minutes.). I tried icing more agressively, but the cold really makes my foot hurt. Much more than how it does normally. The other day I tried doing ice massage, and my foot started hurting and I couldn't even move my toe. It went back to normal once my foot warmed up. Any reason why this would happen? 5 days ago I got a boot put on my foot after the doctor saw the MRI. Fortunately, with the boot on, i'm forced to rest more. Although, this is the most difficult task for me. On saturday, my roommate was DJing at a club, and I ended up going with my boot on and dancing for about 30 minutes. So this is what I've done so far:

1. Stretching (My doc said that by loosening your leg muscles you are making them more useful, so your foot doesn't compensate so much for what your leg isn't able to do)2. Icing: To decrease inflammation, but I can't tell if its helping.3. Rigid soled shoe. (this helps tremendously)4. Dancer's pad. Relieves pressure from the sesamoid. You can make your own with felt or by cutting up insoles. 5. Calcium supplements, and 2000 IU of Vitamin D a day.

I received orthotics from one podiatrist but they suck.

Here are the steps I am going to take:

1. Wear the boot for another week and a half. 2. Get better orthotics to wear in my boot.3. Massage my feet.4. I want to try "yoga toes" because sometimes my toes hurt as well. 5. I want to try that towel activity that a previous poster suggested. I know my feet are very weak because I've been resting them for so long. Also I have no arch in my right foot.6. physical therapy? ($$$)7. Read the book The Resilience Factor, so that I can stay optimistic even though I am so frustrated right now.

I would love to hear other people's SUCCESS STORIES, as well as other techniques, or feedback on what I've done? Thanks!

hey everyone! this is the girl that broke her sesamoid from wearing high heels at work (it's okay, you can laugh!) it's only been 2 weeks since i last posted so I figured people would like to see an update ( I always hate that people don't give an update on these threads bc you don't just want to hear them complain, you want to know the outcome!). the last time I posted my doctor was talking about removing both sesamoid bones (one has a stress fracture, the other sesamoiditis). I am THRILLED to report that with all of my babying techniques and the use of a bone stimulator I will not be needing surgery! I've been suffering from these issues since the end of December so my doctor had basically given me the speech: "At this point, it's about quality of life. you can forgo the surgery and see how long it takes to heal but during that time you will be extremely inactive. OR you could get the surgery and deal with any complications that may arise from that but be guaranteed to be back on your feet in a month or so. You have to decide if you'd rather be injured indefinitely or cure the problem and possibly have to make a few minor adjustments for the rest of your life." I weighed my options and was going to get a second opinion from another surgeon this month to decide. I just came back from my checkup yesterday and the doctor informed me that my foot was finally healing, that I no longer needed surgery, and that I would most likely be able to walk without my foot in about 4 weeks :)!!!!!! Here's what I did that worked for me (Not sure which parts helped the most but I like to think it was the combination):

1.I decided that the health of my foot was my top priority over anything else; friends, family, socializing, boyfriends, etc. I completely focused on my foot. I am, after all, only 27 and a very active individual (hiking, biking, kayaking, etc.) so the thought of having foot issues for the rest of my life was extremely, extremely depressing and I flat out refused to accept it. I decided to basically put myself on bed rest for the next few weeks in a desperate attempt to save my bones. I pretended like I was one of those high risk pregnant ladies from Private Practice and pretended like standing for too long would put me at risk for life-threatening problems. After a few days the mindset really helped. I planned my trips back and forth to the kitchen so I would only need to get up once instead of multiple times.

2.I forced myself to use crutches even though I was told using the boot was okay to do. If I wanted to do an errand I would most likely not even bother since the thought of crutching around was too exhausting. I set myself up in my room. Luckily, I am able to do my part time job from home (it's all internet based) so I was able to convince my boss to do Skype conference calls with me while I rested (I explained the entire situation and again, luckily, have a VERY understanding boss who thought it was the best idea for me). I had my station set up next to my bed with my laptop, countless DVD's, all the korean drama I could find on hulu, healthy snack food (I did, after all, want to stay as healthy as I could given my extreme immobility), painting material, books to read, makeup and nail polish...anything that would occupy my time while I was on "bed rest". I do have to say it was the most depressing and boring time of my life but I just kept reminding myself "what you do now will effect the rest of your life" and stuck to the routine.

3. Starting taking extra Calcium as well as adding a lot of dairy to my diet (usually I avoid dairy because it makes my face breakout but again, foot took top priority!)

4. I was informed that the way I had been walking on my foot was probably what caused my other sesamoid bone to become injured and inflamed. When I had first been diagnosed with the sesamoid fracture I was still walking on the heel and outer edge of my foot, thinking this was a great way to get around. This apparently caused strained on my other sesamoid and the tendons in my foot and I was actually causing further damage by trying to walk on my heel all the time. The crutches solved this problem.

5. Stretching the calf muscles by touching your toes every day to increase blood flow. You want to be careful not to yank on your toes since this will aggravate the sesamoid more. Since my foot was so swollen and tight I would actually grab the bottom of my heel when I stretched so that I wouldn't pull back and hurt the sesamoid more. The idea is to increase the blood flow down by your ankles, not actually stretch the area around the sesamoid. Which leads me to..

6. Do not stretch the sesamoid area AT ALL. I was stretching my toe back when I first injured it thinking it would help and was told this is the absolute worst thing you can do. Your toes might feel tight and swollen but massage gently instead of stretching. Just baby, baby, baby all the time.

7. Ice every time it swells. I would only ice the area when it swelled too tight because the swelling IS the body's actually way of healing itself. some swelling is expected and is okay bc of this but you want to keep it minimal so ice whenever it becomes uncomfortable or noticeably more swollen then usual.

8. Probably the most basic one, but I actually found myself having to say it to stop doing some things: "If it hurts or makes you notice your sesamoid bone at all DON'T DO IT." Sounds easy but I actually found myself reminding myself of this while doing some silly tasks like hopping on one foot while brushing my tooth and bashing my foot against the sink. Let's not try that again and maybe buy a chair, which brings me to..

9. Buy a plastic lawn chair for your shower and get a little plastic or wooden chair for the kitchen or other rooms you frequent. It made me feel like a cripple but having a chair in the shower made shaving and washing my legs and feet so much easier. Plus, no threat of falling and it went along with my "bed rest regimen" so I wasn't standing for a long time and letting blood fill my foot. Having a little chair in the kitchen to sit in while waiting for the microwave or stove to heat up also kept me off my feet. I found one just the right height so I could rest my knee on it and still cook and do the dishes easily while keeping my foot up in the air.

10. Using the bone stimulator. As I stated in my previous post you can get financial assistance for this device and it is well worth the extra medical bill. This item is probably what made the most impact on my recovery. You use it once every 24 hours for 20 minutes but it doesn't hurt to use it more. I use mine 3-4 times a day. Any time my foot would swell up I would use this device and the swelling would immediately disappear. There's no evidence that using it more than once a day helps it more but I figured, why the hell not? I have nothing to lose. My doctor even laughed at me when I told him I used it that much "you know, there's no real evidence..." I told him I put myself on a bed rest regimen...clearly, I was desperate to do anything at this point. He told me to just keep doing what I was doing because my bone was finally showing that it was healing, my sesamoiditis was basically gone and, most importantly, NO MORE SURGERY :)).I hope this helps! Again, not sure if all of these things were helping or if it's mainly the bone stimulator, but if you were like me, I'd try anything that works for other people! GOOD LUCK EVERYBODY! Just stick it out, there's a light at the end of that very depressing tunnel.

Update! 3 years since my last post! i went back to running and martial arts after 6 weeks off and the pain returned. Then I went to see a podiatrist, he put me in a boot for about a month, this helped, it was the only thing that could stop me from running. I started running again after the boot came off with very little pain. Someone asked if I ever returned to martial arts, no, I've been afraid too, it's the martial arts that did this to my foot, not the running. Instead I took up cycling, which causes me no pain, and I'm back running almost as much as I used to. My foot still gets a little achy sometimes, but I believe that is just the way it will be probably forever, and I can live with it. If the pain ever gets bad to the point where it hurts to walk I will cease all running and let it heal. I unfortunately can't wear high heels for long periods of time unless they are very comfortable, I still always try to wear comfortable shoes whenever I can. My issue now is should I sign up for the half marathon for my 38th birthday, it's been a long time since I've done one, pre-sesamoiditis, and I'm afraid that it could come back. I will update this later if I decide to run it. My advice isl take time off exercising at the earliest onset of this problem and you might save yourself years of pain down the line. And don't get down and don't give up, you will be able to be active again, I'm in the best shape of my life right now, thanks to running and cycling!

Thank you for your post! Its great to hear that you're doing so well, and were able to avoid surgery :)

About one year ago I started having pain in the ball of my foot, especially when I did the "lift-off" motion, making it hard to walk. Living in an out-of-state college campus, I had to deal with the pain until I was next able to go home. I was diagnosed with sesamoiditis of the outer sesamoid bone and told to A)stay off my foot and B)begin physical therapy and typical remedies including icing, heating, and nsaids. I'm not an active person, and had not been doing any strenuous activity, so the doctor thought that it may have been my tight calves were just messing with all of my feet in general. I did PT including ultrasound treatments for six weeks, and while range of motion in my foot/ankle increased, the pain remained.

I then went to a different podiatrist for a second opinion. I had an MRI done, and it was confirmed that I had sesamoiditis of the outer sesamoid. Around Thanksgiving I was put in a "walking cast"/ immobilization boot, told to stay off my feet (which is impossible, I'm a college student and my dining hall is a half mile away from my dorm) and to keep  up with the nsaids. He also gave me a cortisone shot in the area.

Then, I had to go back to campus. I wore the boot every day, only taking it off if I knew I was essentially done walking for the day. I wore the boot for five months. While the pain lessened greatly, going down from about a 5 to a 3 on my personal pain scale, it still remained. I could walk without the boot, but I noticed myself beginning to walk on the outside of my foot if I tried to do so.

I went back to the doctor, and he and my mother suggested that I get orthotics put in stiff-soled walking shoes, and start trying to wean myself off of the boot.

I don't see the problem with the boot. I understand the risk of atrophy, but, I much prefer it to the risk of doing more damage to my foot. I've been wearing the stiff soled shoe for about a week now, and the pain in my foot has gone back up to about a 4.5. 

I really do not want to have to get the surgery, but that is what the doctor is pushing for (despite the fact that I have only met with him twice).

Any advice?

Should I keep wearing the boot, or just hope the pain goes away, or is surgery the only option? I understand the risks of cortisone, but I would rather have another injection than do the surgery. I already have foot problems including development of hammer toe, poor foot structure, bad arches, etc. I really worry about what the surgery may do to further mess up my foot.

 

I have had this exact same thing. It is hard to not be able to do anything. I was a dancer. I was good too! I was on a team that was second in the nation, but now I can not longer dance or do virtually any activities. As far as I'm concerned, once you hurt them, they never really want to heal again.

Update from mom of gymnast:

Hi again! So where are you now with this injury?

In retrospect, I wish I had "known then what I know now". As it turns out, it looks like she spent the entire year of 2012 on a fractured sesamoid that was either completely missed by physicians, misdiagnosed, or downplayed. I am thankful after seeing many different doctors at the beginning of 2013 that we now see it as a fracture and spent 6 weeks non-weightbearing (which good for rest but was MORE painful because of limited circulation), 6 weeks in walking boot (still quite painful) and then 6 weeks weaning out of boot into shoes with special orthotics to float the sesamoid which is now just this weekend suddenly making her feel almost completely pain-free.

She has trained this entire time but stayed off of the foot. We added the bone stimulator (20 minutes 2x daily) two weks ago. Since then she has added some eliptical and some handstands and cartwheels in her Asics tennies and the first day she was sore but after that it's like the bone really wanted the blood flowing there again.

It's been a very controlled, planned out and systematic plan for her and I had so many concerns along the way but seeing her practically pain free walking around in shoes right now is amazing. We have not tried any real tumbling and will not for a couple of weeks, as we ease into it, but it's amazing how even the look of the toe has changed so much. It used to be a big, red, hard ball that she couldn't even stand a blanket on before and now it looks completely deflated and normal.

If I were you, and I am not sure where you are with this at this point, but getting a 2nd, 3rd, 4th, and 5th opinion is what was needed. A couple of them were duds, that was for sure. In what is a CLEAR fracture, we've had opinions from very experienced doctors diagnose everything from Turf Toe, sprain, Sesamoiditis, and Bi-Partite. They have told us everything from take a week off to stop babying it and get back into gymnastics. Every one had a different opinion and so you have to find the right one listens to the history, takes careful notes, asks specific questions, knows sports and how important gymnastics is to her and most importantly gives you a diagnosis that fits the symptoms, pain and your GUT and then gives you a treatment plan that is conservative and consistent.

I've found most orthos just do not believe these gymnasts at age 10 and 11 can break a sesamoid, so they don't look much further on an xray feeling that pain there is treated all the same. I've insisted on xrays each month to show progress and there hasn't been much, but a little, and it gives me great comfort to see it with my own eyes. Many docs don't think you need to know. But as Mama Bear, of course you do!!

~Amy

Hi All

Thanks for all of your stories and advice, greatly appreciated.

I first had sesamoiditis about 8 years ago, a pronator wearing orthotics who massively upped his fell running mileage in no support/cushioning fell running shoes! I had extra cushioning added to my orthotics and dropped the fell running mileage/time spent wearing those pesky fell running shoes. Probably took about 5 years before the pain totally went and no sign of any issues. Since then I've been more aware of types of fell shoes I wear, types of running shoes I use, and sadly very rarely walk about bare footed (I wish!). No sign for years until last weekend. Did the Old Man of Coniston Triathlon which involved a 12 mile run mostly on fell but about 2 miles at the start and then at the end on road/path. Fell running shoes helped me descend off the mountain (Old Man of Coniston) like a nutter but sadly did me no good on the paths and roads. So sesamoiditis back with a vengance, wearing lots of cushioning at the moment, and have cut down my running to virtually nowt.

Lesson of the story is always be on the ball (not literally!) and stay alert. I know that we're not all the same, but just shows how it can just happen more than once over time. This time I had no prior niggle or warning.

The other thing is that I was always given the option of having the sesamoids removed, at the time quite a new operation in an unknown field. I fought the urge as I'm not a fan of surgery if I can help it. However a word of warning. I have a friend who had them removed years ago and he reckons he's in more pain now than he ever was, really regrets it. Pain has never gone. Of course this is only one person, so if you're thinking of going down this path do your research peeps.

Happy recovering to all, Clive