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Monday, September 1, 2014

Sesamoidits: Email Advice

Good morning Dr. Blake
Hope you are doing well . I wish I can travel to meet  with you as I know you re the most expert in these fields.
I have emailed you few month ago regarding my chronic ( 9month) sesamoiditis , maybe was a result of my hallux limitus.
That was later developed to algodystrophy (aka reflex sympathetic dystrophy).
I have waited for the MRi results so I can send you a better picture , I hope the pic below is fine. Sorry for the long email

Displaying photo.PNG

The Mri results mentions only two anormalities :
·         A small kyste synovial of 4 mm in second articulation metarso-phalagienne( sorry it’s in french I am trying to translate)
·         A small ostheophytose in the first arcticulation metarso-phalangienne.
·         The report mentions nothing regarding the sesamoid bones although I am in pain. ( can you please check the picture attacehd if they are fine coz one seems not that healthy for my eyes)
Dr Blake's comment: I agree that the sesamoids do not look perfect, but that would be accepted if you are getting some bone remoldeling with healing. It is the 2nd joint with the cyst plantarly and some soft tissue reaction that looks the most involved at present. Does it hurt on range of motion of the 2nd joint, or palpation of the 2nd metatarsal head? The sesamoid injury which started, developing the algodystrophy, may be healed by now. See if you can send the T2 image of the same view where the bone is dark and swelling shows up bright white. 

Here are my symptoms :  I have nothing of the usual algodystrophie symptoms you usually read online , such as changing in skin colors , nails droping or hair loss…ect
My bad foot even looks 98% as my good foot , don’t have any swelling or feeling of heat..
but I have sharp pain in my sesamoid after walking 10 min max without orthotics.
When I wear orthotics pain increase in my heel.  When I don’t pain incresae in the sesamoid area ( so basically I am lost here)
Dr Blake's comment: Why do you think the orthotics give heel pain? Can that be remedied? Maybe the orthotics need more padding in the heel or a slightly different design. This seems crucial to getting you well. Try if some Hannaford version can be made for you. I would have 5 different pairs with different qualities if needed to experiment since this is so crucial to you. It is not unreasonable to be in the orthotics full time for the next 2-3 years as the bone continues to heal the sesamoid. 
For the last two month or so I have been swimming or biking on daily basis ( biking with orthotics to avoid pressure on the sesamoid , I don’t know if you recommend)
Dr Blake's comment: Definitely, biking, swimming, elliptical, typically are great if you can avoid bend of the toe and excessive weight on the sesamoid. 

I appreciate your recommendation regarding my case , since I so down lately with this hard case.
Note that I cannot affoard a bone stimulator since it’s not covered by insurance here “ I don’t know if it’s needed”
Dr Blake's comment: If the sesamoid on the T2 image is still very white then a bone stimulator would be wonderful. Once you send me that image I will place on this post. 
I was considering buying used ones on Ebay but I am not sure which ones to pick and if they are good or have high counters.
Dr Blake's comment: I love Exogen from Bioventus!!



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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.