Sesamoiditis: Email Advice

Dr Blake,

Thank you for the wonderful blog. If it wasn’t for your blog I would have had no idea to make any progress with my sesamoiditis.

The first podiatrist I went to diagnosed me with a fracture from the left foot x-ray, the second podiatrist (who is supposed to be the best in Denver) said there was no fracture on the x-ray and at my insistence ordered an MRI. The MRI also showed no fracture just inflammation in the bone and surrounding tissues

               -          This doctor has given me no advice on getting better other than insisting I                   get    an orthotic made from him and take a cortisone shot (which I refused)

                    Dr Blake's comment: Good for you. It is the long-acting cortisone that we           worry about in a joint. 

-          My pain started in mid-sept and I went to the doctors almost right away.

  I was in the boot for 6 weeks.

 I had zero pain in the boot 

Dr Blake's comment: Yes, you get injured and you do what it takes to create the 0-2 pain level for healing. The secret is to figure out how to keep it as you wean out of the boot and into normal activities. But, you achieved the first part well. 
  My left ball of the foot still feels swollen and makes it uncomfortable to walk on barefoot

Dr Blake's comment: For most bottom of the foot problems, no barefoot walking until you have been completely fine for 2 months. The removable boots never get rid of swelling, and in fact, the velcro straps can trap the swelling in the foot by slightly cutting off the venous return back to your heart. 

 I use Dr Jill’s dancer's pads and high-arch over the counter orthotics.

 I bought Hokas and have been pain-free in them. I am able to walk for 30 minutes in them.

Yesterday I tried a spinning class and unfortunately I am feeling a bit of discomfort today ( I can’t tell if it is good pain or bad pain)

Dr Blake's comment: Spin should be fine. Initially do not get off the seat, and lower the resistance a little. Also, ice right after, and one more time that night for 5-10 minutes. 
 I do contrast bath 2-3 times a week

Dr Blake's comment: If you are swelling, contrast baths starting at one-minute heat one minute ice for 20 minutes, along with pain-free massage and perhaps some PT to remove the swelling. 

 I am naturally too pronated and my ankle rolls inwards

Dr Blake's comment: If your orthotics center your weight, then they are helpful. If you assess how you walk through them, see if you think you should have a higher arch. 

-          Questions for you

How do I get back to activity? I haven’t worked out in 11 weeks and I feel very unhealthy. I tried swimming but my work hours are crazy and it isn’t possible to swim other than the weekend

Dr Blake's comment: Typically it is mixture of impact (walking and advancing to a walk-run program), non-impact (elliptical or spin or stationary bike without the sesamoid on the pedal), and cardio (swimming is the best mixed with some spinning)  The spinning class gave me some pain – should I try it again? Yes, see above.  I am very unclear on how I try to get back on my feet and normal again and the doctor is giving no guidance

Dr Blake's comment: When you hurt your foot, you need to restrengthen your foot, but also condition your legs and core. Many people need the advice of a PT or trainer or both, to get the deconditioned feeling out and get powerful again.   What physical therapy exercises should I try?

Dr Blake's comment: Try to find my description of the well you make to float your sesamoid when weight bearing. Typically four books of an equal height slightly offset to stand on with the sesamoid in a hole or floated. Then you can do your two positional calf stretches, your toe raises (start two feet only), your single leg balancing,  ankle therabands, knee extensions and flexions, and other core work.  I still have swelling but prior to the spinning class had zero pain, is it normal for swelling to stick around? Yes, see above, but you must work on it. 

I feel really depressed all the time with the lack of physical activity and the inability to wear normal shoes to work (I bought some vionics recently and will try them once this bout of spinning class pain subsides)

Is there a doctor in Denver, CO that you would recommend? I need someone who doesn’t try and force me into cortisone shots. 

Dr Blake's comment: I have heard good things about Dr Stephanie Parks. Let me know what you think. Rich

Any help and guidance from you would be much appreciated.

Thank you!