Reduce pain & swelling with cold compression

The 1st step for conservative treatment of your sesamoiditis is to reduce the swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required to heal sesamoiditis injuries. This is why for years doctors, trainers and other medical professional have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.
Cold Compression Therapy slows nerve and cell function - reducing the swelling that blocks blood vessels from doing their job. This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through the tissue and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues as the cells don't get the oxygen they need to survive. By limiting the amount of damage done to your tendon, you also limit the amount of healing that needs to occur. This is a very important step to heal tendon injuries faster and with less pain! This is why you need to treat your sesamoiditis foot pain right after it's hurt, when you notice pain / swelling / inflammation, or directly after a re-injury. Applying cold compression right away will stop the damage immediately and unblock your blood vessels to let your body's natural blood flow in to start healing the tissue.

It'll seem weird for you to read this, but there are a LOT of people out there that don't understand how fast cold compression can get the swelling / inflammation around your sesamoid bones under control! After you get rid of the swelling for good you can start dealing with your sesamoid injury and pain head on.

24 to 72 hours after your initial injury or when you first notice pain and swelling in the ball of your foot to stop cellular damage, relieve pain, and decrease swelling.

1. After exercise, workouts or activity of any kind to prevent re-injury of your sesamoids.
2. Before and after surgery during rehabilitation to control pre and post-surgery pain and swelling.
3. Anytime you feel your sesamoiditis has made your foot tender, painful or you're having a flare-up of an old sesamoiditis injury.
4. Anytime you have swelling, sharp throbbing pain or inflammation in the ball of your foot.
5. Any other situation where you need to draw the pain and inflammation out of your foot.

What if You Need Surgery?

Whether you need to have surgery and the type of surgery you'll have depends on the severity of your sesamoiditis and whether you have a fracture in your bone. The longer you've waited to have surgery or try conservative treatment methods will also be a factor to decide if you need surgery.

Has it been weeks or months since the injury?

An acute (recent) case of sesamoiditis is usually treated with conservative treatment methods, like rest, minimizing activity, cold compression and Blood Flow Stimulation Therapy^™ as we mentioned before.

Doctors and surgeons will always avoid surgery if possible because recovery from the surgery can be a lengthy process, in most cases your sesamoid bones will have to be removed reducing the mobility of your foot. Doctors always prefer minimally invasive treatments which is why they suggest conservative treatment first. Your doctor and surgeon know that a surgery will involve altering the structure of your foot, and so they will recommend treatment to avoid surgery at all costs.
If you have a fracture that's not healing of you have a fracture that puts your bone in multiple pieces, your surgeon might perform a sesamoidectomy (removal of the sesamoid bone).
Scar tissue will be problematic for long-term recovery after surgery.

As with any surgery there are risks to every procedure depending on a lot of factors, including your age, the severity of your injury and your level of health going into the procedure. It's always best to discuss all possible risks and complications with your doctor, orthopaedic specialist and/or surgeon before the procedure. It's important to be aware of the risks you may face with any procedure intended to fix or relieve pain from your sesamoiditis.

Sesamoidectomy

If you suffer from a regular (acute) fracture or stress (chronic) fracture in your sesamoid bone and conservative treatment methods haven't been successful in healing or relieving pain, then your doctor may suggest a sesamoidectomy surgery. During this procedure your fractured or injured sesamoid bone (or pieces of the bone) will be removed. Removal of this bone is meant to ease pain and promote healing in the area.
This procedure will be done by making an incision on the side of your big toe. The surgeon will then seperate all of the underlying soft tissues to get to your sesamoid bones and visually inspect it. Once removing some or all of your sesamoid bone the surgeon will use sutures to attach the end of the tendons together or connect it to the remaining bone.

One of the major risks of this surgery is how removal of your sesamoid bone(s) will affect the structure of your foot. Since the sesamoid bones act as pulley's on the bottom of the foot for tendons that control your toes, removal of one or both of these bones will remove important leverage needed for the foot to work properly. There is always a risk that removal of your sesamoid bone(s) could affect the shape or angle of your big toe. You might end up with 'claw toe' (where your big toe is bent up) or your big toe could slant towards your second toe. You could also end up needing to have the rest of your sesamoid bone left removed if it gets fractured in the future.

This is why doctors encourage conservative treatment methods first, and surgery only second IF the conservative methods of healing don't work.

Sesamoid Bone Graft Surgery

The only other option for sesamoid surgery is a bone graft. This is usually only performed when you continue to have issues with a stress (chronic) fracture in your sesamoid bone(s). During this procedure your surgeon will take some bone from big toe (this is called an 'autogenous bone graft') through a second incision, and then use that bone to repair the areas that aren't healing properly in your sesamoid.

Sesamoidectomy is always preferred over a bone graft as it's a minimally invasive surgery. This bone graft procedure is also only ever considered for high performance athletes.

Your rate of recovery after the surgery will depend on how dedicated you are to the conservative treatment method recommended by your doctor, the type of procedure that you had and your efforts in physical therapy.

No two rehabilitation plans are alike - Generally speaking the less invasive your
surgery is, the quicker your road to recovery will be.

• Sesamoidectomy - You may need to wear a cast for 2 to 3 weeks, then follow that with a walking brace for another few weeks. Physical therapy can start 2 to 3 weeks after your surgery and you may be able to return to some modified form of your regular activity by week 8.

• Sesamoid Bone Graft Surgery - This procedure will have a longer recovery period, starting with you wearing a cast for 3 to 4 weeks. That's followed by a walking cast or boot to be worn for another 3 to 4 weeks. Physical therapy may start anywhere from 4 weeks after surgery to 8 weeks after surgery. Other assistive devices like orthotics or arch supports may be prescribed to help you along with your recovery.

What if You Don't Have Tendonitis or a Fracture?

There are 3 more injuries that can happen in or around your sesamoid bones resulting in sesamoiditis pain:

• Intractable Plantar Keratosis (IPK) - this is like a callus or corn that's formed on the ball of your foot under your big toe that can cause sesamoiditis-like pain. Over time this callus / corn can develop into a larger lesion with a very painful sore-spot in the center.
  
  If left untreated, this condition can lead to a more serious sesamoiditis injury, reduce range of moition / mobility of your foot and change the way you walk on your foot. Conservative treatment methods are used to treat this injury. Surgery is only ever recommended if you continue to feel pain and have reduced range of motion even after using conservative treatment methods.

• Osteochondritis (Avascular Necrosis) of the Sesamoid Bone(s) - This is a condition where blood supply to 1 or both of your sesamoid bones isn't available. Over time reduced blood flow to your sesamoid bone can actually cause a portion of your bone to die (this is also called 'necrosis'). Your body will try to heal this injury by building up extra calcium (bone) around the dead spot.
  
  This can sometimes happen if you've suffered from a chronic ("stress") fracture in your sesamoid bone that hasn't healed properly. In most cases conservative treatment methods won't work to treat this condition and surgery will be needed to remove the sesamoid bone (reference: 1, 2). If surgery is required, conservative treatment methods can then be used during post-surgery rehabilitation.

• Nerve Entrapment - There is a major nerve that runs near our big toe and second toe called the 'Medial Plantar Nerve'. Even though this nerve is usually not close to the sesamoid bones, nerves can sometimes naturally be in areas where doctors don't expect them to be. It's possible to be suffering from sesamoid pain, with the pain really coming from your medial plantar nerve if it's running under one of your sesamoid bones. If you've had an x-ray and multple tests done to see if you have sesamoiditis or a sesamoid bone fracture and there is no definite result, you might be suffering from nerve entrapment in that area.
  
  Your doctor can see if you have nerve entrapment in this area by doing a test called 'Tinel's Sign'. During this test the doctor will lightly tap near the painful area to see if you feel any tingling or 'pins and needles' sensations. If you feel tingling that runs down your big toe, you might be suffering from nerve entrapment (reference: 1).

• Sesamoid Arthritis - Sometimes you may have cartilage damage under your sesamoid bones between your sesamoinds and the bones in your toes. This cartilage damage can lead to arthritis, a painful inflammatory condition causing stiffness and swelling in your joints. You could have sesamoid pain that is really a case of arthritis under your sesamoid bones. Any signs of arthritis around your sesamoid bones should show up in an x-ray.

What is sesamoid tendonitis?

Sesamoid tendonitis (sometimes spelled tendinitis and pronounced 'tendinitus') is irritation and/or inflammation of the tendons surrounding the sesamoid bones.

You will feel this irritation and/or inflammation when there is a strain, damage or micro-tearing in the tendon tissue.

Anyone can suffer from sesamoid tendinitis - for younger people it usually happens from repetitive movement of the toe in athletic activities like baseball and ballet. In adults, this injury can happen from over-use OR degeneration of the tissue as we age.


You could have different types of sesamoid tendonitis including:

• Tendinosis - a condition caused by chronic degeneration (wearing away) of the tendon fibers over time.
• Tendinopathy - chronic inflammation of the sesamoid tendon(s) that results from many small tears over from from over-use or repetitive movements.
• Tenosynovitis - damage or micro-tearing to the sheath covering the sesamoid tendon(s).

It's possible to have tendonitis / tendinosis / tendinopathy AND tenosynovitis at the same time, creating a more complicated sesamoid tendon injury.

Do you really have sesamoiditis?

Our feet are some of the most complicated joints in our bodies with 26 bones, 33 joints and more than 100 tendons, muscles and ligaments (reference: 1).
Big toe pain can be from injuries to the sesamoid bones or the soft tissue in the foot, some of the more common injuries being:

• Foot bursitis - Bursitis can occur in the toe joints, the side of the foot, the heel and around the ankle. As we walk, run or jump, the ground surface and the shoes we wear play an important role in how much trauma our feet experience. Every step can cause a small amount of damage to a particular area in the foot which can increase the risk of bursitis.
• Morton's neuroma - This condition usually causes burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. You may sometimes feel that you are "walking on a marble," and you have persistent pain in the ball of your foot. You may also have numbness in the toes.
• Metatarsalgia - This condition can also cause pain in the ball of your foot, that area between your arch and the toes. Metatarsalgia is a common over-use injury, persistent stress can lead to chronic irritation and inflammation of the bone covering and surrounding tissues, such as ligaments and tendons.
• Plantar Fasciitis - Pain associated with plantar fasciitis normally starts as a dull ache and then progresses to a sharp, knife-like pain or constant throbbing feeling that is worse when you put weight on your foot. The most tender areas tend to be in the center of your heel and along the inside and bottom of your foot towards your toes, where your heel and arch meet.
• Turf toe - This can happen when the big toe joint is pushed beyond its' normal range (backwards or downwards). A 'pop' is felt at the moment the injury happens followed by sharp immediate pain. Symptoms include swelling in the foot, the entire big toe joint is affected and limits the motion in the toe.

My book covers remedies to help every single one of these problems. It details the most comprehensive list of modalities available today. I have documented my experience with most of them and give you accurate and up to date information on what works and what doesn't. I have seen some of the best doctors in the nation and present to you all of the accumulated knowledge I have gained over 2 years worth of trial and error.