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Wednesday, September 10, 2014

Sesamoid Injury with Complex Regional Pain Syndrome: Email Advice

Good morning Dr. blake hope you are doing fine .
Thank you a lot for your help ,
Just wanted to update you regarding my algodystrophy (aka complex regional pain syndrome).
Sorry for the long mail .

I did a new X-ray which shows some areas of bone demineralization in my foot “ including some small stripes on the sesamoids”  unfortunately they didn’t give me a CD so I cannot send them to you.
The MRi didn’t show demineralization “ doctor said it’s normal in algodystrophy”
I have the synovial fluid of 4 mm under second metatarsal but doesn’t seems to cause any pain , and doctor suggested it will disappear on it’s own.

I did very good progress after 2,5 month , so now I feel my pain is mainly mechanical ‘ from bone loss” no more nerve issue I guess.
And I did a lot of efforts to relax , since there’s a real relation between pain and stress or anxiety.

Acupuncture helped me a lot , it also removed the inflammation from the sesamoid area like magic from the 2nd session.
and swimming was also beneficial.
I have reduced now my smoking habit. And trying to quit , I know this is bad for blood flow.

I can spend now an “ almost “ normal life with the help of orthotics and 2-3 Advil per day
My pain level vary between 2-3- and maximum of 5-6 – but I keep walking sometimes even with pain , since the doctor told me it’s better for bones to heal faster.

I started to feel now that I might be , from the lucky guys who will finish algodystrohy  within 6 month time frame. Still have 3.5 month So I cross my fingers.

I am mostly worried about the sesamoids areas , it is the place where all this hell started for me , and it’s the most painful site in my algo as well.
 the original tendonitis injury seem to be gone as you predicted ,
but I was wondering how long it would take for these sesamoids bones to be normal again and make mineralization.

I am afraid to live all my life in orthotics as sesamoid are very stubborn , and I read all those “ horror stories online about people stuck with this hell”
 Since my original tendonitis 10 month ago , I have tried several brands and went to professional people for custom made.. bought a lot of shoes..ect
Orthotics always coz discomfort in other areas of the foot as you know , the stress from this issue made me so anxious for 9 month and  This is what launched my regional pain syndrome I guess.
and I work in outdoor sales , so life is not fun at all with orthotics.

You told me to wear orthotics full time , and I am doing that now , even  at home
Only take them out for the shower or for the pool,

I now wear Reebok easy tone  with custom made orthotics , that what I found most comfortable.
but I hope if you can give me the name of a brand that makes  classic and formal shoes for men ideal for sesamoids.
Since at work I am supposed to wear a suit with tie and now obliged to wear jeans , I tried MBT but couldn’t balance in it and felt like wearing ladders.
this would help a lot to have something similar to easy tone but formal or classic.
Any other advise for shoes is great.

If I need a bone stimulator and I am abroad and cannot have a doctor prescription here , how we can arrange to buy it ?
And If I do buy them ,  how this would affect my healing ?

I appreciate your help

Dr Blake's comment: Thank you so very much for your email. Ebay does sell bone stimulators, but I would call Bioventus company and explain your situation. Patients do get them without an Rx online, but someone typically has to help you with an RX. I am glad the neurological part is calming down, but be careful of producing pain over level 2. I wish I could convince all my, and other, success stories that heal their sesamoid injuries. It not only happens, healing occurs in the vast majority of cases. Orthotics also are part art part science. Forces on the foot are very hard to predict and the orthotic prescriber has to be very good at the art part of it. There are so many dress shoes that have removable inserts that fit a version of the orthotic that you have. But, that is the direction, dress shoe with removable/replaceable insert that you should evaluate. I hope this helps. Rich


  1. dear Dr blake -
    thank you for your help. who posted about sesamoiditis that was transformed to algodystrophy.
    it's me again . i wanted to update you regarding my algodystrophy.
    after 2 month of relatively fast improvements,i left crutches and started to feel better but
    now i am down again and feel this life is seriously a hell hole.
    there's no more enhancements since the last two month , things got worst and my left leg started to hurt , first i thought it's due to the pressure shifting but symptoms started to become like another algodystrophy, the doctor said , yes they sometimes move , with
    50% less power than the first time. actually i feel like my pain got some sort of mirroring to the next leg .
    but i had an Xray and there's no bone dimeneralisation.

    my main pain mainly comes from my heels - ( since sesamoid and fingers are alleviated)
    i am really starting to loose hope , i don't go lots of places and this is really affecting my family and my work.

    i was wondering since i tried more than 5 types of orthotics - all hand made and were adjusted several times - and they all in a way increase pain in both heels, does orthtotics normally put more pressure on the nerves or on the heel ? or this is related to my feet being weaker or... i donno..
    this week i will consult a neurologist , sicne my pain moves sometimes between both legs , i donno if a neurologist is the right person to see for my condition , since i already seen an orthopedist , and a rheumatologue just to confirm that i don't have rheumatoid arthisis.
    by the way please let me know as per your experience , how much a sesamoid bone needs as healing time after being demineralized??

    i never thought that foot problems can destroy a life in this way.

    1. I am so sorry that this problem is getting worse. Look at my posts on the checklist for CRPS and see if there are areas that you are not addressing. Calmare Pain Therapy may be the answer so I would check their website for locations near you. You need to see a pain management specialist with interest in CRPS. Definitely orthotics place pressure on the bottom of the foot nerves and can make them unhappy. I love the Hannaford based ones (see the blog) as the best version for support and cushion. Sesamoids that have demineralized can take up to 5 years to strengthen, so continuing a protected weight bearing environment makes sense for at least several years as long as your function continues to improve. Keep me in the loop. You are in my thoughts and prayers. Rich

  2. thank you Rich for your reply.. you are a blessing to all who are suffering out there.
    oh my god . 5 come a broken sesamoid heals in less than a year while demineralized bone can take up to 5.
    i don't want to do any sports or running- just want to walk on two legs without pain , like human do.
    if i buy an exogen bone stimulator , i can reduce 5 years to how much?
    - also do you recomend toe fusion ?
    - i bought a pair of MBT yesterday and wore them with orthotics. they relieved 80%of my heel pain/ it's not the most relaxed shoes but that made me feel better.
    i have read in many places on french websites that 70% of aldodystrophy of the foot cases can heal in 6-12 month ,and often without leaving any traces.
    while 30% heal but leaves some traces mainly muscles weakness or stifness, but i don't have any stifness or claw toes so my doctor was reassuring about this part;.

    so now i am confused....): after your statment of 5 years. haven't slept yesterday ):

    1. Demineralized bone can take u to 5 years to strengthen back to normal because you are at the same time using protective weightbearing principles etc.
      Using an exogen bone stimulator for a 9 month period will definitely reduce the time, but I'm not sure how much time.
      Fusing the big toe joint is a permanent thing that you can never go back, and it is always a last resort.
      Glad the MBT shoes were helpful to you.
      I would not focus on the 5 years because healing is a bell-shaped curve and you can be on one side or the other. Each month continually work on strength, protected weightbearing, anti-inflammatory, and see how the next year goes.

      Keep going,


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.