Dr Blake's comment: This is a hard call. You have pain from 3 sources: mechanical (being off weighted by the hapad and/or orthotic, inflammatory (do the twice daily 10 minute ice pack, and once daily contrast bathes), and neurological hyper-sensitivity (try Neuro-Eze, pain free massage). Everything needs to be perfected. Look at each component since a littel change in anything can potentially make a big difference. Can you tolerate a bit more arch? How about a little more dancer's padding. If you are not immobilizing, perhaps a hike and bike shoes for several hours per day to rest the area better. Sometimes just go anti-inflammatory program, or consistently wearing spica taping.
MRI of the left foot
Technique: Routine multiplanar imaging of the left forefoot was performed on a 1.5T MR scanner according to standard protocol.
Comparison: None available.
A skin marker has been placed along the plantar-medial aspect of the forefoot at the level of the tibial hallux sesamoid.
There is a homogeneous low signal of the fibular hallux sesamoid on T1-weighted and fluid-sensitive sequences, likely reflecting sclerosis, which can be seen in the setting of avascular necrosis. The tibial hallux sesamoid appears within normal limits.
There is no evidence of acute fracture. The joint spaces and alignment are maintained. The articular surfaces are intact. There is no significant joint effusion.
The visualized extensor/flexor tendons and ligaments are intact.
There is no Morton's neuroma. There is mild first webspace intermetatarsal bursitis.
There is no abnormal signal in the musculature to suggest atrophy or denervation.
The subcutaneous tissues are unremarkable.
Findings compatible with avascular necrosis of the fibular hallux sesamoid.