Sesamoid and Sciatica? Email Response

Hello Blake, I have read many of your blog posts about sesamoiditis and have tried my best to apply them to my injury. After a long period of issues I have decided to reach out for you personally for help.

I am (was) a high school runner and this injury occurred during December of my junior year (nearly a year ago as I am now a senior.) I had been running 50-65 miles per week during my cross country season with no big Issues. Only this lingering upper hamstring/piriformis issue that would appear when sitting for long periods. A deep, stabby type pain in my upper hamstring/piriformis. This is important later. In early December I had been having issues with numb/burning/tingly toes on my run. Along with plantar fasciitis type issues. I had attributed these issues to new shoes I was trying out, but I am now guessing these issues were pre-cursors to my sesamoid issue.

Dr Blake's comment: The upper thigh, heel pain, and toe numbness could be a sign of sciatic nerve irritation. 

One day I was running when I suddenly got a piercing pain in the ball of my foot. I hobbled home and rested. I have to this day not run because of the injury. In the following weeks, a lot of inflammation and dull aching was common. Still having no idea what it was. I stayed off of it as much as possible and did some icing.

At one point I went to my massage therapist and she mentioned my right leg was basically twisted out side ways. My hamstring/piriformis/hip were all screwed up. This led me to (and I still) believe that due to those issues changing my gait, I was putting excess pressure on different bones in my foot; causing the sesamoiditis. This theory may or may not be true. She worked on me and said it was better than before, but still not good. I didn't touch it after that.

I got x-rays in January that showed no issues with my foot. Inflammation and occasional ache remained, but the ache was less frequent than before. In April I got more X-rays. This time with different angles at a foot specialist. This revealed inflammation in one of my sesamoid bones. They gave me a foot pad to offload the bone and claimed it would heal itself soon. At this point the inflammation was still there and the bone didn't ache as much as before. I never wore the foot pad due finding it to be uncomfortable, now I know this was probably dumb. I went around in flip flops and barefoot all summer and the inflammation remained. I specifically remember it would ache when I woke up.

I found your website in September/October and have been applying some of your recommendation since. I wear the foot pad at all times around the house and have a similar set up in all my shoes. I ice multiple times a day and every couple days I do the contrast bath. There is rarely ever any pain, so I would put it in the 0-2 range. Maybe slight pain every couple weeks, most likely after I do something stupid to it. I also supplement with some calcium/vitamin d/magnesium to be safe. My question is: What else can I be doing for this injury? I feel the bone is healed, but some inflammation remains, but I feel the bone has been just about healed for a long time. The inflammation has been the real issue that refuses to go away. I can't wear certain shoes because my right foot is bigger than my left, I don't dare to run on it, etc. It has been almost a year and while I have made much progress from where I was 6-12 months ago, I am still sick of this inflammation. What can I add in to help? Am I doing anything wrong?

Dr Blake's comment: I would definitely see a neurologist or physiatrist to rule out sciatic nerve irritation versus piriformis syndrome. This could be causing some hypersensitivity along the L4 nerve root distribution. See my video on this. 

https://youtu.be/E0E60NpOSHg

Here is my issue with the upper hamstring/piriformis. It still gives me the deep stabbing pain when I sit in certain positions or for too long. I am wondering if you think there is any connection with this? Could my gait theory be correct? I have since begun hamstring strengthening exercises (specifically for my issue, which I believe may be a high hamstring tendinopathy injury) to try fix this issue as all the stretching/massaging in the world did not seem to fix it. I have been doing these for a couple weeks. Do you have any experience with this?

Dr Blake's comment: The pain syndrome seems to point to the sciatic nerve. Also, nerves hurt sitting or sitting or resting, and tendons with activity. So, that would be my next investigation. Good luck . Rich

Thank you for your time.