Dr Blake's comment: Sesamoids initially hurt mechanically due to the injury, and then the inflammation comes in causing its own pain. When you were woken up for two nights, you probably had a combination of inflammatory pain and neuropathic pain (the pain produced by the pain itself and your body making the area hypersensitive to protect itself. So, you seem to have addressed the neuropathic pain, and stiff shoes helping with the mechanical pain. Keep icing 10-15 minutes twice per day, and contrast bathing in the evening for the inflammatory pain.
Dr Blake's comment: The high arch feet seem to do better with Brooks Ghost or New Balance 928 with narrow width selections. The 928 has a rocker forefoot. For cross trainers, I like the New Balance 608. I sure hope this all helps. Good luck. Rich
- Exogen bone stimulator for 6 to 9 months
- Removable boot or a stiff soled shoe like Hike and Bike for 3 months to create a consistent pain free (0-2 pain level) healing environment.
- Ice pack twice daily and contrast baths each evening for anti-inflammatory and deep bone flushing. Do the contrast baths twice on non-work days.
- During the initial 3 months of immobilization, have orthotic devices developed that off weight the sesamoids.
- Learn how to use 1/8th inch adhesive felt from Moore Medical to make dancer’s pads for the boot and for post-boot action.
- Learn how to spica tape for post boot action
- When you are not wearing the boot, avoid barefoot.
- Do cardio, core and foot and ankle strengthening the minute you hurt the bone, and on a daily basis. Keep Strong and Keep Fit!!
- Since we are dealing with bone metabolism, make sure your calcium and Vit D intake is good, and get counseling if you think that there might be a bone density issue.
- Use strict activity modification principles to keep the pain levels between 0-2 as you go from boot to regular shoes. The weaning out of the boot period can take anywhere from 2 to 6 weeks and no added soreness is allowed.
- They rarely do not heal.
- Even with normal healing, they can take up to 2 years so patience is a virtue here (some fast and some slow, and all patients want the fast ones).
- Healing, and feeling better, is based on many factors that are unknown when the patient first presents.
- MRIs and CT Scans are common imaging techniques that can really elucidate the problem, and sometimes change the direction of the treatment.
- Follow up MRIs, when needed to check healing, are often done between 5-6 months after the first baseline MRI.
The patient's response: