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Saturday, October 26, 2019

Sesamoid Pain that is Possibly Nerve Pain

     I had a wonderful chat today with a young lady from the East Coast. She has been treated for sesamoiditis for a long while, with many opinions, and recently a very smart PT said that it may be her nerves. The sesamoiditis is on both sides, and produced by going from orthotics to no orthotics over night. There has been no swelling, MRIs are negative except some swelling in the tissue around the sesamoiditis. She wore a pair of wedges that put more weight on the sesamoids but actually felt better than flats. She has an intolerance to shoes. She has a documented L4/L5 stenosis at 49 years old with minimal back issues, and disabling foot issues. She had a negative Nerve Conduction Test.
     All these findings point to nerve pain as a problem and I told her to seek a peripheral nerve doctor that understands the concept of Double Crush. I told her Nerve Conduction Tests were document nerve damage but not nerve hypersensitivity. She may need an epidural or something that is invasive, but she can start with topical nerve creams like Neuro Eze or Neuro One, neural flossing, warm soaks or contrasts, B complex supplements, TENS units, loose shoes (sorry for winter coming), and no prolonged stretches and learning how not to irritate the sciatic nerve. PTs can teach that.
     One of the golden rules I have learned about nerves is that all of the treatments to help can irritate when you first learn them. I have shown each of the above, and most of the time the patients feel great and that they help, and then another patient will say it irritated them immensely. I apologize, and try to modify with less intensity in general. If you treat pain, and what you commonly do irritates a patient, it probably documents you are dealing with nerve pain. 

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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.