https://www.drblakeshealingsole.com/2019/08/sesamoid-avn-email-advice.html
For anyone that might read through this with similar problems - I am the patient in this email correspondence. As I write this comment I'm 6-months further along - it's Jan 2020. I'll update again in another few months. I spent about 6-weeks non weight bearing on my left foot and then another couple of weeks after that in one of those big boots you can walk in. I spent 3-months through to November contrast bathing every night and I've been using an Exogen bone stimulator on my left foot every night for the last 5 months. After the boot I transitioned into New Balance Fresh Foam More shoes with some home made orthotics to off-weight the sesamoids.
For whatever reason over the summer my right "good" foot also became painful in that big toe region and I freaked out and ended up getting that MRI'd as well. It continues to be sore in that same sesamoid big toe joint area but the MRI showed up pretty benign. I've continued to exercise throughout although being pretty conservative with my activities. I haven't tried pushing it too hard yet but I'm curious to see how my feet handle more aggressive activities.
My current status is a pretty much constant low level discomfort and stiffness feeling in both feet in that sesamoid/big toe joint area when I'm walking. It ebbs and flows a little bit but I haven't had severe flare-ups at all in the last 6-months. I've done a little walking bare foot, played with my kids fine, swim regularly even pushing off walls, bike rides, done a couple of short hikes, and worn dress shoes for work on occasion. It's not perfect and I haven't done any running or played soccer at all - the background level of things doesn't really feel much different to when I was diagnosed with these issues 6-months ago - but it was really the flare-ups and not being able to walk without hobbling that was the most debilitating.
I'm not willing to take any more aggressive steps like surgery at this point. Especially considering my right foot acted up as well and there's not really any way to pinpoint exactly what the problem is with that. I was taking a lot of anti-inflammatory meds to be able to function before I got formally diagnosed with this issue last summer. I'm not taking any now and so I at least feel like I'm establishing a good background level of functionality. It's concerning to me that the background level of pain and discomfort hasn't really improved or changed at all in the last 6-months but at the same time I'm working on finding the balance with how highly I can function activity-wise. My next step is to get some custom orthotics and further define what kinds of footwear can help me diversify into increased and more aggressive activities.
For anyone that might read through this with similar problems - I am the patient in this email correspondence. As I write this comment I'm 6-months further along - it's Jan 2020. I'll update again in another few months. I spent about 6-weeks non weight bearing on my left foot and then another couple of weeks after that in one of those big boots you can walk in. I spent 3-months through to November contrast bathing every night and I've been using an Exogen bone stimulator on my left foot every night for the last 5 months. After the boot I transitioned into New Balance Fresh Foam More shoes with some home made orthotics to off-weight the sesamoids.
For whatever reason over the summer my right "good" foot also became painful in that big toe region and I freaked out and ended up getting that MRI'd as well. It continues to be sore in that same sesamoid big toe joint area but the MRI showed up pretty benign. I've continued to exercise throughout although being pretty conservative with my activities. I haven't tried pushing it too hard yet but I'm curious to see how my feet handle more aggressive activities.
My current status is a pretty much constant low level discomfort and stiffness feeling in both feet in that sesamoid/big toe joint area when I'm walking. It ebbs and flows a little bit but I haven't had severe flare-ups at all in the last 6-months. I've done a little walking bare foot, played with my kids fine, swim regularly even pushing off walls, bike rides, done a couple of short hikes, and worn dress shoes for work on occasion. It's not perfect and I haven't done any running or played soccer at all - the background level of things doesn't really feel much different to when I was diagnosed with these issues 6-months ago - but it was really the flare-ups and not being able to walk without hobbling that was the most debilitating.
I'm not willing to take any more aggressive steps like surgery at this point. Especially considering my right foot acted up as well and there's not really any way to pinpoint exactly what the problem is with that. I was taking a lot of anti-inflammatory meds to be able to function before I got formally diagnosed with this issue last summer. I'm not taking any now and so I at least feel like I'm establishing a good background level of functionality. It's concerning to me that the background level of pain and discomfort hasn't really improved or changed at all in the last 6-months but at the same time I'm working on finding the balance with how highly I can function activity-wise. My next step is to get some custom orthotics and further define what kinds of footwear can help me diversify into increased and more aggressive activities.
I have AVN of the sesamoid, long story. Bottom line: off load for 3-4 months but DON'T stress out the other foot doing so - which means babying both feet for the entire time you are in the awful boot -or else you might find you get fracture or AVN in other foot (it happened to me). Don't go barefoot EVER, ANYWHERE. Use Oofos inside your home (or Teleks). No high heels ever.again. get used to it. Buy & use the Exogen machine 2x/day even though it's $500. Get custom orthotic inserts, pay out of pocket if your insurance won't. It takes a LONG TIME to heal - if you are lucky and not too far gone. You can't push or rush it, so pain is very important information to guide your level of activity, therefore avoid NSAIDs to mask the pain. Find the right shoe for you - Hoka One One Bondi model works for many people.
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