I'm a very fit and aggressive 65-year-old hiker and backpacker who left the Bay Area eleven years ago for a remote small town in New Mexico.
I have high arches and I pronate, and my left fibular sesamoid was diagnosed with a displaced stress fracture 27 years ago, and was excised dorsally. I was given no further recommendations or precautions at the time.
Pain in that area began recurring . Since then, I've seen three different podiatrists, none of whom ordered radiology and none of whom diagnosed a sesamoid problem. No one has ever analyzed my gait. They all simply prescribed new orthotics, and now I have four sets of expensive prescription orthotics, only one of which provides reasonably good arch support.
The latest pain began three months ago. Our (only) local podiatrist likewise just recommended yet another set of orthotics, but it took over a month to get them, so I continued hiking with stiffer boots, adding a metatarsal pad to my best existing pair of orthotics, on my own initiative.
, the pain became acute and I had to stop hiking. I rested it for a couple weeks, but it got no better and began aching at night in bed. Then I iced it three times a day for another two weeks. The ache went away, and the pain (on loading) decreased, but only to a point, so I returned to the podiatrist and requested an x-ray. After reviewing it, he said the tibial sesamoid appears deformed and may be fractured. He said if it is, he will need to remove it and fuse the joint, likely resulting in permanent disability. He ordered a CT scan and left on a three-week vacation before the results arrived.
As in the past, he didn't suggest any further precautions or limitations, but on my own initiative, I conscientiously keep the load off that joint. What little walking I need to do around the house, I use my best orthotics/met pad, take short steps, and walk on the outside and heel of the foot to keep pressure off the joint, and I also keep the foot flat to avoid extension of the big toe. For anything more strenuous, like driving my truck with clutch, I wear my heavy hunting boots with orthotics/met pad to distribute the load over the arch and outside of foot, continuing to avoid big toe movement. This way, I've been able to avoid all but intermittent light pressure on the sesamoid.
In the meantime, I've researched the condition online and find that time is of the essence in treating a fractured sesamoid without surgery. I'm already three months into this condition and I've read that four to six months is the window for preventing nonunion and potential avascular necrosis.
My next appointment, to receive and discuss results of the CT scan, is . I am EXTREMELY frustrated with how long this problem has been recurring, and how bad it's gotten, without adequate attention, diagnosis, and treatment. I'm concerned that my local doctor may only give me the option of debilitating surgery, and I've learned from previous experience that our local physical therapists have limited experience and limited availability, usually with a month-long waiting list.
I'm open to traveling anywhere, for example back to the Bay Area, for more aggressive treatment to keep the use of my foot. I've read about treatments like hyaluronic acid injections, platelet-rich plasma injections, rejoining a fracture with wire or screws, arthroscopic debridement, shock wave therapy, bone stimulator, biomechanical analysis, gait analysis, spica taping - none of which seem to be available here. Here, I haven't even been given a walking boot to keep the load off the sesamoid.
Do you think I should be patient and wait for a local diagnosis on , or should I be looking into outside options ASAP?
And regarding outside options, it seems that sesamoid conditions are often difficult to treat. Should I really be looking for a medical team with deep experience in sesamoids, or do you think any general podiatry practice would be sufficient?
Thanks for your consideration!