T Nation

Damaged Sesamoid

Hi there guys,

I’ve finally taken the step after many years of reading T-Nation to sign up and get amongst the forums.

Considering the quality of readers & writers the site offers I thought I’d get opinions on how to treat a dodgy sesamoid. It’s almost been two years since I did the damage - It was on the beach kicking a footy around when I stubbed my toe and this was the first stubbing of my toe that it grounded me.

I first thought it was a broken big toe and treated it as such. However, in the interim I went and spoke with a specialist about 9 months ago and he mentioned it could have been a damage sesamoid and continued to do various scans, all which came back inconclusive.

He said that they could make special orthotics to elevate the sesamoid and reduce the load - considering it’s a load bearing bone. At $2,500 a pop I opted to no go down this path, as I couldn’t justify the costs - however I’m not sure that was a wise decision considering the pain is still there.

The pain affects all movement requiring running, jogging, sprinting etc - So my questions is has anybody had to deal with a sesamoid related pain and how have you dealt with it. Call me an idiot for not going ahead with the orthotic route - which I’ll kindly take on the chin. But, could you tell me the chances of improvement if I did decide to invest in those orthotics.

I haven’t been able to do exercises such seated calf raises or any direct calf exercises.

Greatly appreciate any advice guys.

Thanks!

~Nick

sorry man, I’ve got nothing for you, but stay positive and I’m sure you can get past it

Thanks Larry :slight_smile:

No way in hell any orthotic for you condition should cost 2k+. No matter what they tell you and whatever marketing material they give you, it’s a freakin shaped piece of plastic with a divot under your big toe to give it room and probably an arch support because that’s their solution to everything.

First, how have you determined this to be sesamoiditis? ‘Stubbing’ usually means you hit the toe from the front, this would more likely be an MTP joint (big toe joint) problem, sesamoid would be more from an impact from the bottom of your foot. Does it hurt to bend the toe up and back? My guess this is more of a turf toe type injury. What scans exactly did this specialist do? X-ray, mri? You need an mri to really get anything conclusive.

If it’s pressure that hurts, just buy a ‘dancers pad’ with the hole cut out (or just cut out a spot on your regular insoles and see if it helps). If it’s more of a bending up pain get something like the x1 blade to keep your toe from bending.

After that your best bet is finding a good manual therapist that can mobilize and maybe break up some scar tissue, etc. After that you can try injections like ultrasound guided (a must) prp, prolo or ESWT shockwave treatments. Your very last resort is surgery but there’s a lot of risks with this joint and should be avoided if possible.

[quote]Brackz wrote:
Stuff about Sesamoid[/quote]

Hey Nick,

I signed up today, basically to give advice on the sesamoid issue.

I had a broken sesamoid bone in my left foot for 9 months before I had surgery. My mistakes in getting it treated were down to my own ignorance and that of two of the doctors I saw. I’m a trusting person (read: fool) and here’s what happened with me:

  1. Wake, up, foot angry, red and sore. Regular doctor is off golfing or whatever, go see Urgent Care Doctor, who tells me I have gout
  2. Spend next month reading up, changing diet, no booze (sad face), foot stays bad
  3. See regular doc, who laughs and says “No way you have gout!”, orders x-ray, which shows a split down left sesamoid, he suggest specialist, so off to sports Podiatrist
  4. Podiatrist tells me I have a bipartite sesamoid, which has separated and gets me $300 (not $2500) orthotic to fix problem. After 5 months, not fixed. “Oh well, in that case it’s probably broken, we can cast for 5 weeks or surgery and you’ll be walking next day”. I had recently been laid off so I took surgery while I still had decent medical, as the cast was not guaranteed, plus after 9 months of seeing docs, I was over it.

And voila! It was fixed…

Now’s the sticky part:

I lost both big toenails after playing two days at a tournament (ultimate frisbee) some time later and went to a new Podiatrist that was closer to where I lived. While discussing my terrible lack of toenail cutting, we discuss the scar on my left foot and that’s when he says “Did they x-ray your other foot?”. “Um, no, they didn’t”, I tell him. Apparently bipartite sesamoid if you have it, will almost always be in both feet. The doc should have x-rayed both and then we would have known early on if orthotics was the answer…

Basically, a few things to take away:

  1. Make sure you’ve had x-rays (possibly on both feet, if they mention bipartite), you might need a bone scan
  2. See at least TWO different Podiatrists about this (look for sports specialists as this can be common for runners, so they’ll have seen it before)
  3. If it is just injured and not a bone fracture, I have no experience, if it is a break and they offer a boot/cast, go for the boot/cast first before surgery if you can. It’s not a difficult or painful surgery/recovery, just if I had known sooner I would have gone for the cast.