Sesamoiditis: Email Advice

Hi Dr. Blake,

I am so grateful to have found your blog about sesamoiditis. I have had it for three months and I've tried everything (complete rest, ice, anti-inflammatory, physio, acupuncture, custom orthotics, a boot, taping), and I've been five weeks non weight bearing completely. But I still have swelling and pain.

Dr Blake's comment: Any time someone mentions non weightbearing I know that the pain and swelling are going to last longer. When you go non weightbearing, the tissues swells much more, since weight bearing with every step pushes the fluid back towards the heart. Swelling is the body's way of healing, bringing in the right stuff, but it always brings in more swelling then it needs, and the non weight bearing does not allow you to get rid of it. 

I've decided to get a cortisone injection. The doctor said if I haven't had healing from all the rest yet, I need to take  the next step. 

Dr Blake's comment: Cortisone, without knowing what the tissue looks like on MRI is risky. One hopefully is fine to shrink swelling, and diagnostically should tell you if all the pain is actually coming from within the joint. 

My question is how long I should keep my foot off the ground after the shot (to prevent tendon rupture)?

Dr Blake's comment: As long as the joint is within the joint, there is no weight bearing restrictions. You can not run for 2 weeks!!!

Should I go weeks non weight bearing? 

Dr Blake's comment: As soon as you can stop non weight bearing the better, but that has to be your doctor's decision (and you of course). 

And how long before I do some gentle foot exercises? 

Dr Blake's comment: Typically, even if you are non weight bearing you can do met doming, Single leg balancing with shoes and orthotics, posterior tibial and peroneus longus therabands, and achilles stretches. Remember, if there is weight bearing and if the exercise puts too much weight on the injury, you can stand on 3 or 4 books next to each other, with a hole for the injured area. Hope that makes sense. For the achilles stretch, just putting the front of the foot off a 2 inch thick book works. 

When can I deep water pool run?
Dr Blake's comment: Now!

 I'm willing to rest completely for as long as it takes, as this has been the worst experience of my life. I'll do anything to heal. I'm just afraid that this shot is only going to be short lived. 
And in your opinion, is it true that some people never ever heal from sesmoiditis? 
Dr Blake's comment: No, I have never seen a patient not heal from sesamoiditis. I have seen injuries that were called sesamoiditis, but were something else that required surgery. That is why I would even self pay if you have to for an MRI for peace of mind to know exactly what your diagnosis is. 

Thank you in advance. I'm hoping I'll be one of the lucky ones to whon you are able to reply.
Dr Blake's comment: This was sent during my vacation to Spain, so I am 3 weeks late. I hope it still helps. Rich