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Saturday, January 5, 2019

Sesamoid Injury and Hallux Rigidus: Email Advice


This wonderful patient has both sesamoid pain and hallux rigidus pain on the left foot. He flew to see me twice because of this blog. He is also having low back pain and I had recommended our back doc to see him also. He is an avid hiker and is trying to avoid surgery. He taught me that Dr. Jill's dancer's pads make a huge difference even on top of my best orthotic devices with their own dancer's padding and I have been recommending that to patients since. They experiment with the 1/8 to 1/4 inch heights of the Dr. Jill's dancer's pads. This email was sent one month after I saw him.


Rich,

Just wanted to update you my progress and clarify a few points. Feel free to use any relevant parts of this in your blog!

1. The trigger point injection (lidocaine) by Dr. Hong did not help my lower back at all. In fact, since sitting aggravates the pain, it was much worse after the long wait in his office, and I had a very challenging flight back to Indiana to visit family that weekend. But pain did gradually fade, as always. I'm still researching ideas for treatment, but at this point I don't have much hope of preventing recurrences. I know seating and bedding are hugely important - the friends I was staying with have no ergonomic furniture, and I blame that for most of my pain while staying in the Bay Area.

2. Your little suggestion of icing the sesamoid after every walk/hike has worked wonders to sustain my mobility. For the past month, I've been able to restore much of my cardio conditioning due to that little trick - icing and resting 2 or 3 days after each hike before heading out again. I'm still limited in distance and terrain, but assume that will gradually improve.

3. Still unable to find carbon foot plates with sesamoid cutout, but I did get the basic plates from Dr. Jill. Unfortunately despite their thinness, I still can't use them for two main reasons: (a) combined with orthotics, they occupy too much space in footwear. I'd have to buy new shoes at least a half size larger. (b) The hardness of the carbon plates under the thin cushioning of my blue orthotics seems to create too much stress on the sesamoid, and using them with the Hannaford's is out of the question because of total thickness.
Dr. Blake's comment: I understand. I guess you have to take the full plate and have a shoe repair shop grind out the sesamoid area so you are still overall immobilizing for the hallux rigidus while off weighting the sesamoid. Sorry to send you on a wild goose chase.

4. Need a little clarification on sesamoid condition. Referring to the radiology I had at St. Francis in September, am I to assume that there was probably a partial stress fracture of that sesamoid last year, and that the surface of the bone has since healed, leaving only the internal healing process to complete? I understand that at my age there's probably a fine line between some types of injury and arthritis.
Dr. Blake's comment: Between the sesamoid irregularities and the first metatarsal irregularities, it is difficult to actually tell what is healing (strong enough to take normal load) and what still needs time. I know you can co-exist with most of this stuff with some protection and be very active.

5. Regarding the Exogen ultrasound device, you mentioned that the device itself could be causing the sesamoid to appear "hot" in the radiology images. I remember that last year, you recommended to stop using the device 3 months before a follow-up MRI, but I didn't do that this year. Is there a point in the coming year at which I should stop using the device, to let the tissue "calm down"?

Thanks again!
Dr. Blake's comment: You are welcome. Next August, based on where you are at with your symptoms, let's decide what images, if any, are needed. This year, 2019, hopefully you will be exercising a lot. Happy New Year. Rich

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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.