A letter from Maggie, really bad sesamoiditis

Hi Greg,

I don't know if you will have time to write me back, or if you actually write people back, but I'm taking a shot in the dark because I just bought and read your book (PDF version) about sesamoiditis, and as I have for the last nine weeks, I want to cry because I am so frustrated. I am a Canadian who is making a special trip to see a sports medicine doctor (who is also an orthopedic surgeon) at Cleveland Clinic on Monday. I don't know what I'm going to do. I feel like I've done everything, and this is never going to get better. I just began the acupuncture (four sessions so far), and I ordered the TENS machine and bought rocker shoes (although I'm using crutches now).

I was wondering why you didn't mention MRI in your book. Is bone scan preferable to MRI? I'm booked for an MRI on Monday (an x-ray was normal), but now I think a bone scan is what I should get. You also didn't mention if swimming or pool running is ok because I did this for the first few weeks, and here I am, into the third month with this injury, and no better, so maybe the pool wasn't good either? What are lifelong athletes supposed to do if they can't even swim? Or do yoga (no toes)?
If you have any time to reply, I thank you sincerely. I am so completely despondent that I honestly don't know what to do.

Thank you.
Maggie

Maggie,

I don’t typically ever respond because there is no way for me to know your exact situation. I will give you some basics and will make the assumption you aren’t dealing with fractures (no matter what the x-ray says.. x-rays are usually non-conclusive). It sounds like you may have fractures that are not healing “yet”

What I would do:

1. Get the MRI... It can't hurt and may show something else as the problem or something else in addition to the actual problem. 

2. Get the bone scan. The x-ray not showing anything doesn’t really mean anything. The person reading the x-ray has no baseline image to compare to and the x-ray is not conclusive.

3. Do not do "any" activities that hurt it until the pain subsides or at the very least there is “no” inflammation at all. (Don’t even walk on it until you do #11 below)

4. Be sure to take hi-res images of your foot. Use your cell phone if needs be. Keep a diary of what it looks like. Measure it with a measuring tape. You manage what you measure.

5. Don’t overdo the acupuncture, you could make it worse. 

6. Buckets with ice water for 10-20 minutes, 3 times a day do wonders.

7. Ibuprofen and NSAIDS work wonders. Do a tapering regimen like the book says. Do not overdo this either and make sure you are okay to take ibuprofen.

8. It took 2 years for mine to go away completely and I did EVERYTHING, except surgery and I didn’t get a cortisone injection.

9. If you do anything to flare the area up, you are taking 2 steps back for every 1 step forward.

10. I had sesamoiditis bad in both feet.   After 3 months of doing things the right way and letting the inflammation subside, I was able to run again with a modified gait. And when I say run I mean run a lot even with it. www.ungermotivation.com

11. The rocker shoes are “decent” but they will not compare to going into a good Pedorthist and having them custom make an orthodic for you in the shop.  They will be able to make an orthodic which will take ALL of the pressure off the ball of your foot. Way better than a rocker shoe and way better than an orthodic from a podiatrist or Orthopaedic’ s office.  The pedorthist will keep modifying the orthodic until it is perfect.

12. Even if you don’t use this orthodic to run in, it was KEY in my recovery since any kind of walking made the ball worse.

13. I give all different modalities in the book, because everyone typically has something slightly different.  

I hope that helps and good luck.

Greg