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Friday, August 24, 2012

Sesamoiditis: Email Advice

Hi Dr. Blake,

Thank you so much for your helpful blog. I have been diagnosed with sesamoiditis in both feet. The pain in my left foot is much worse than my right but the MRI shows significantly more swelling in the right foot than the left. Does that make sense to you? Is it possible that the pain is being caused by something other than the sesamoiditis?

I also had a question about taping. Is taping necessary if bending the toe does not cause pain? Flexing my toe does not seemingly increase my pain but I'm wondering if I should tape anyway. 

Finally, I had an MRI but my doctor was unable to determine whether I had a fracture or not. Should I be concerned that even with the MRI he cannot tell? Should I look for someone else to treat me condition? If so, do you have any recommendations in the Boston area? 

Thank you so much!

Dr Blake's Response

     The diagnosis of Sesamoidits is much like Shin Splints, a catch all word or phrase that could mean alot of things. X-rays are historically inaccurate, missing subtle injuries like stress fractures, that you do not want to miss. So, I relie on MRI imaging more than anything else to show bone, ligament, or tendon abnormalities. Since you had an MRI, and there is still a question of fracture or not, it is probably just the interpretation. Some docs use the MRI to look for a visible crack, when a stress fracture will show none. The question I need to know is whether there is any changes in either Sesamoid on T2 imaging where the Sesamoid should be black but it appears white. That is a stress fracture and should be treated accordingly.  So, it is definitely possible that your pain can be something more than just inflammed sesamoiditis, since I rarely see sesamoiditis cause swelling.

     You need to get a copy of the official MRI report, but I would get a CD of the actual images. Try to find the ones that look like the images from my blog and see what you can gather from this. I will be happy to look at the CD or any images you send. 

     In regards to swelling, deep swelling that you can not see can be much more painful than superficial swelling. It is why patients can come in with enormous ankle swelling after a sprain and say that they are still running on it. And, why a drop of swelling due to an ingrown toenail can bring patients to almost tears.

     Taping is a possible help for some activities. You need to practice taping for various activities about 10 times to get good at it, and see if you can tell a difference. For your injury taping is equivalent to an ankle brace post ankle sprain. 
     The 2 sports medicine podiatrists that I know in the Boston area are Lloyd Smith and Michael Robinson. You can get their numbers off the website from the American Academy of Podiatric Sports Medicine. I hope this is helpful.Rich


  1. Hi Dr. Blake,

    I am so grateful to have found your blog about sesamoiditis. I have had it for three months and I've tried everything (complete rest, ice, anti-inflammatory, physio, acupuncture, custom orthotics, a boot, taping), and I've been five weeks non weight bearing completely. But I still have swelling and pain. I've decided to get a cortisone injection. The doctor said if I haven't had healing from all the rest yet, I need to take the next step.
    My question is how long I should keep my foot off the ground after the shot (to prevent tendon rupture)? Should I go weeks non weight bearing? And how long before I do some gentle foot exercises? When can I deep water pool run? I'm willing to rest completely for as long as it takes, as this has been the worst experience of my life. I'll do anything to heal. I'm just afraid that this shot is only going to be short lived.
    And in your opinion, is it true that some people never ever heal from sesmoiditis?

    Thank you in advance. I'm hoping I'll be one of the lucky ones to whon you are able to reply.

    1. Julie, I answered in my blog post Sept 30th 2015. Hope it helps. Rich


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.