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Saturday, October 28, 2017

Sesamoid Healing: Patient's Account of Healing

I have emailed with this wonderful patient for quite some time. He got into a terrible state of deconditioning and nerve hypersensitivity when a physical therapist (true healer) decided to help (and I mean really help). Everyone's story of healing will be different. What works for one, may not work for another. You have to keep trying, doctors may give up, but you can't. You have to assume that there is an answer to your problem that is around the next corner. This is a heart-wrenching and wonderful story. I know how hard he worked. Here's to continual healing. Please be kind to leave comments. Thank you. Rich

Dr Blake,

Hope all is well for you!  Thought I would share some thoughts on my battle with sesamoiditis 

A recap - about 18 months ago I began to have swelling in the ball of my foot which soon showed up in my other foot.  Went to many doctors who kept telling me to rest and if I had pain it would not heal etc.  After an MRI the doctors said I had stress fractures in the Sesamoids in both feet.   Went to multiple physical therapists that could not help either and I kept getting weaker and weaker.  I lost about 30 pounds, started having pain all over my body.  I got so weak I struggled to even take a shower.  If I had to walk much I used a wheelchair.   I went to doctor after doctor and tried OTC orthotics, custom orthotics, walking boots, cortisone shots, opioids, antidepressants, tons of different shoes but nothing seemed to help.    I went to many PT sessions over 4 months with two different physical therapists and that did not help either.  Finally, after 10 months a lady from my church suggested I contact a physical therapist that she had used with success.    She saved my life!   I began therapy and the first day she had me cancel my appointment with a particular Orthopedic surgeon and had me schedule with a different one.  Obviously, a PT knows which surgeons to go see since they have to help everyone rehab after surgery!  We had several sessions and after a few weeks I was getting stronger but the pain was getting worse.  I went to my appointment with the Orthopedist and my PT went with me!  (That should tell you how bad of shape I was in!)  I had seen Psychiatrist, psychologist, Internist, Podiatrists, Orthopedic surgeons, Rehab specialist and the Physical therapist helped me more than anyone had so far!  The doctor said I had AVN but told us that I had to fight this and I was basically released to full activity.  From that point, the therapy got a bit more intense and the pain for two days after each session was terrible.  The PT kept telling me I would get better and to just push through it.  I was now more active but my feet hurt and got much worse as the day progressed.  They had gotten so weak from all the resting that I heard comments like your feet feel like baby feet.  Well the PT was right - I'm still doing the exercises she showed me and I'm able to do anything I want to do.  I still have some pain when I sit for a while but once I get moving the pain goes away.  The PT expects I'll still have some discomfort for the next 6 months but expects it to totally go away by then.  I wanted to share some of the things I did that helped me the most.   I'll never know for sure what caused all my issues but I suspect shoes were a part of it.  

  1.  Never stop moving - that led to weakness all over my body and hip, back, knee and foot issues.  
  2. Find a good PT no matter how many you have to go to to find one - make sure the PT knows all about strengthening feet and hopefully has experience specifically with sesamoiditis
  3. The PT suggested Asics shoes - I tried them on and immediately they were wide enough to take pressure off the sesamoid area.  I had tried Altra, Hoka, New Balance etc and the Asics were the only ones that were wide enough for my feet and did not have too much cushion.  Initially, a stiff shoe was OK but later I needed to have flex back in the shoe.  
  4. Cushion is not necessarily a good thing in shoes - My feet really don't have much cushion on the fat pad so I thought that a more cushion shoe would help but it actually made things worse.
  5. Took Vitamin D - my counts were low around 30 initially - also spent more time in the sun
  6. Took Calcium supplement
  7. Used an Exogen bone simulator as Dr Blake suggests using
  8. Specific exercises that helped -  Wobble board (stretching and strengthening), Busu Ball (marching),   foam wedge (stretching while standing), Side lunges, riding a stationary bike, Walking (making sure to walk normally), Marbles (pickup with toes), Standing on one foot and planks.  Also used a Total Gym to help with upper body etc during this time.   
  9. Orthotics are not necessarily good for your feet - I think they actually caused more damage than they helped.  Once my feet got strong again I really didn't need them. Dancer pads caused all kinds of pain for me- I think I may have needed them in the first month but after the bone healed they had to go!
  10. Lots of stretching will help - use the foam wedge mentioned above and do the gastroc stretch.  It doesn't seem to do anything quickly but over time will help.  make sure to do a warm-up before stretching or you'll cause more issues.
  11. A spikey ball will give a deep tissue massage.  You can find them on Amazon and it really helped me early on.  

If anyone is having trouble like me my thoughts are with you.  I wouldn't wish this on my worst enemy but thank God the worst seems to be behind me!  

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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.