Sesamoiditis in both feet and Inflammation

by Ann
(Washington, DC)

Hello! Thanks for all your tendonitis advice! It’s greatly appreciated. I’ve had Sesamoiditis in both feet for about 8 months now.


I’ve started doing Ice Dips and taking glucosamine about 2 weeks ago, previously I had been doing Ice Massage- but in both cases, the inflammation keeps coming back.

When I Ice Dip I leave my feet in the ice water for 10 seconds, rest for about 30 seconds, and repeat 10 times. I usually repeat this about 4 times a day. Is this the correct procedure?

Most of my uncontrollable inflammation occurs either at the end of my work day before I leave to go home, or before I go to bed. In both cases the inflammation usually worsens on the metro ride home, or during my sleep.

I have a desk job, so I’m usually not on my feet at work. It takes me about an hour to commute on the bus and metro, which does involve some walking.

I’ve tried doing an Ice-Dip before I leave work, but sometimes this seems to exacerbate the inflammation. I’ve even tried ice massage when my foot isn’t inflamed to try and get ahead, but this seems to worsen the irritation in my Sesamoid bones and surrounding tendon.

Am I icing correctly? I’d greatly appreciate any advice! Thanks!!



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Joshua Answers:

Hello Ann.

Yikes. No fun.

Sesamoiditis is problematic because essentially the bones are embedded in tendon, and a lot of structural force/tension/pressure hits those points of tendon between bone.

This site has a nice little overview about Sesamoiditis. Orthoinfo.aaos.org on Sesamoiditis

A couple thoughts, then a few questions.

1. I would put a little more time between ice dips. You want to give the body time to pump new blood into the area before redipping and flushing fluid out again. You could wait a little longer, or alternate hot/cold.

4x/day is great.


2. If you've been doing that much for 2 weeks, it's either successfully keeping you at this pain level, or it's not doing the job.

I'll compare sesamoiditis to Tenosynovitis, in that ice dipping won't do too much for the ACUTE inflammation and particular physcial make up of the problem.

Essentially, the tendon, and likely the connective tissue wrapping the other bone the sesamoid bone/tendon press on, is bruised. And every step you take irritates it.


Tenosynovitis can show up anywhere Tendonitis can (as long as there is a tendon sheath involved).

See: What Is Tendonitis?


It's great you're ice dipping. It is keeping the overall problem from getting worse by keeping the overall ecology healthier, but it's tough to get circulation to the actual trigger spot that is constantly launching a Process of Inflammation.

More suggestions the next round after I get more information.


Questions:

1. What kind of footwear do you wear? High heels? Pointy toed anything?

2. Weight/height ratio/description? Looking for how much force is translating down to the feet.

3. Say more about how ice irritates. The more detail the better.

4. Seen a podiatrist/shoe kind of professional? If so, what happened with that?

5. Feet hurt when you first get up in the morning? Hurt at night in bed, or when you are -off- your feet?



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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
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Nov 28, 2009
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PART 2 - thanks for your response! - Sesamoiditis in both feet and Inflammation
by: Anonymous

Thanks for your quick response! I appreciate it very much :-)

To answer your questions- I have been seeing a podiatrist regarding my Sesamoiditis, and I wear MBT shoes with orthotics per his suggestion.

I was also in physical therapy for about two months where they stressed stretching, strengthening exercises, and icing. I'm 5'7 and weigh 130 pounds.

Since my original post I've had an MRI which showed that I have "minor arthritic changes" to the cartilage between the plantar surface of the first MTP joint and the Sesamoids.

Because of these new findings I have started taking daily vitamin supplements shown to help arthritis, I've been walking less, and trying to strengthen and stretch the muscles in my ankles and legs daily. So far this has helped with the pain and swelling.

My podiatrist strongly suggests getting cortisone shots in the joint to help with the pain if the problem isn't feeling better in a month, which I am considering.

He's hopeful that I can still recover since I am relatively young (29) I hope so, fingers crossed!


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Joshua Comments:

Interesting.

1. What vitamins are you taking, and how much?

2. What is your Vitamin D level?

3. How is your digestion and energy levels?

4. What does the doctor expect the Corticosteroid Injections to do, specifically? And does s/he suggest that you stay off the foot after the shots. That makes a certain amount of sense, assuming the shot actually stops the pain and lowers the inflammation.



I'm definitely a thumbs up to the icing and stretching!



Jan 04, 2010
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PART 3 - Supplements and Cortisone Injections - Sesamoiditis in both feet and Inflammation
by: Ann

Hi Joshua! Thanks for your response :-)

My daily supplements are as follows: Cosamin ASU (glucosamine, chondroitin, ASU), MSM, SAMe, a "high potency" multivitamin, Omega 3 fatty acids, and calcium plus vitamin D. I get about 800 ISU of vitamin D daily (from both the multivitamin and calcium supplement).

Before I started the supplements I was definitely dragging, but now my energy level is great! The Cosamin and SAMe have definitely been a BIG help with the pain and swelling. My digestion has also been good so far, I hope it stays this way.

I decided to have the Cortisone injections before the holidays (this was my first time trying these). They made my feet extremely sore for about 3 days, then it successfully kept the swelling down for about 4 days.

My activity level hasn't changed, I try to stay off my feet as much as possible. Now things seem back to where I was before the shots.

I've decided not to get them again, since there hasn't really been much benefit that I can see (so far). I've read that cortisone can damage cartilage, which scares me- I hope it didn't make things worse!

Thankfully I've only had one, most of the damage I've read about is with multiple shots. I plan to talk to my doctor more about this the next time I have an appointment.

So basically, now I'm back to icing after activity, and I also do ultrasound massage once a day. I've kept up with my daily stretches and strengthening exercises.


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Joshua comments:


Might as well get a Vitamin D level while you're in there too. 800-1000i.u.'s is an infant's dose. Loads of research studies say you should quadruple that as a maintenance dose.


Well, that' good information at least the the shots only helped for four days. Now you know.

With such a boost from the nutrients, I would look more in that direction for the 'cure'. If you have a joint pain dynamic from nutrient deficiency, no surgery in the world will help. Nore will shots, nor massage, etc.

If your body is lacking, and hurting, you have to heal your body by filling up what it's missing, and giving it time to move itself back to normal.



Feb 27, 2010
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PART 4 - update, acupuncture - Sesamoiditis in both feet and Inflammation
by: Ann

Hi Joshua,

I want to update you on my progress, I've been seeing a new physical therapist for about a month now with a very different approach. They do electro-acupuncture, acupuncture, acupressure, deep tissue massage, and cupping to increase the circulation and control inflammation.

So far the inflammation has subsided, which is great! The treatment is very focused on increasing circulation, and they have told me that I have poor circulation in my feet, they are always cold. I think this may be why icing too frequently was exacerbating the problem.

Anyway, I have a question about your response to my first post- how is Sesamoiditis similar to Tenosynovitis? Is it an injury to the tendon shealth? Should try to immobilize my feet and rest as much as possible? Is every movement re-injuring the tendon?

Thanks again for your help!

Ann


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Joshua Comments:

Great Ann, I'm glad you're feeling better! Sounds like that physical therapist is going to town on your feet. Great!

I'm glad they're focusing on circulation. One way or another, it's all about circulation.

How is Sesamoiditis like Tenosynovitis?

Basically, tenosynovitis is an irritated tendon sheath (connective tissue very similar to tendon) that has a hair-trigger irritibility. Meaning if it's unhappy, it can go from 0 pain to 10 pain in a VERY short amount of time.

Sesamoiditis is a dyanamic where little bones are floating in the tendon. The tendon gets irritated and very unhappy. It's not necessarily 'injury', but it is definitely IRRITABILITY.

'Happy' tissue and 'unhappy' tissue isn't very scientific, but essentially, while tendonitis can be painful, tenosynovitis (and sesamoiditis) are a special kind of painful...hair trigger, stubborn to get rid of, taking very little to increase symptoms.

So my point with the comparison is that the tendon is HIGHLY IRRITABLE, which makes sense that it's getting ground between a couple of bones...and the ground.


Should you rest? Well, probably, yes. But -just- rest will likely take an unrealistic amount of time.

With massage and icing and and and, you can greatly speed up the benefits of rest. So it's kind of a balance of self care and ongoing irritation. If you get add more benefit than irritation, you'll eventually win.



Also, you might want to check out 'neuroma pads'. They're what I was describing before.


Thanks for keeping me updated. Please continue to do so.




Feb 28, 2010
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PARt 5 - heat with cold therapy?
by: Ann

Hi Joshua!

Thanks for explaining the similarity! It makes much more sense to me now.

Right now I'm focused on using heat to increase circulation to my feet, per the instructions of my new physical therapist. At home each night I use a heated foot bath for 30 minutes and ultrasound massage wand for 15 minutes on each foot.

Would icing enhance the effects of this routine? If so, what kind of icing treatment would you suggest (ice massage cups, ice dips, etc.), for how long, and before or after the heat treatments? I am concerned that the ice might be a bad idea given my weak circulation in my feet.

What would you suggest?

Thanks,

Ann


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Joshua Comments:

If the heat is working for you, great.

I think adding cold would enhance, yes.

If you do ice, I'd go with either an ice dip, 10 seconds a pop, as often as you like. Generally I say always end with cold, but some bodies just dont' like that, so cold first, then heat. Or heat to get a lot of blood in, cold to super fulsh it out, then heat again.

Or an ice massage, specificaly on the areas that hurt, and then into heat.

Basically, if it's a bad idea -for you-, then don't do it. And, maybe experiment to find a balance of doing it some/a little to get the benefit, but not the downside.





Sep 13, 2010
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update from Ann
by: Ann

Hi Joshua,

It has been a while and I wanted to update you on my progress.

I was recently diagnosed with Joint Hypermobility Syndrome, so as it turns out I don't have a circulation problem but a genetic collagen defect. Though I don't have this to a severe degree, my extremely weak muscles from all the rest have put even more stress on my tendons.

Subsequently, I have been working with a physical therapist on a lot of strengthening. She has recommended PRP (platelet rich plasma) treatments for my sesamoiditis to start a new healing cascade by adding growth factors to the tendon.

I haven't had the procedure yet, but in preparation I have to stop taking NSAIDS and glucosamine (and other anti-inflammatories) for 3 weeks. I'm continuing to take the rest of my supplements for hypermobility, many of which help with collagen production (vitamin C, D, Lysine, B's, Magnesium, Calcium, multivitamin, omega 3 krill oil, carnitine & CoQ-10, and whey protein drink)

Because I need to stop taking glucosamine, I've been looking into bone broth as an alternative. Would this help the tendon repair in my recovery, or would it have more of an anti-inflammatory effect? (which I've been told to avoid)

Also, I go to a generic grocery store which doesn't have a butcher. They do sell bones, however. Could I purchase any kind of beef bone for the broth, or does it need to be a specific type to work?

Thanks again for your help,

Ann


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Joshua Comments:

Hi Ann.

So, Ehlers Danlos?

Yeah, that's no fun. Now it's a game to keep the body as strong and supportive as possible.

1. Ideally you want organic bones. You want the good stuff from the bone, not the bad stuff

We use the thigh bone, but any bone will do.


2. Bone broth isn't necessarily an anti-inflammatory, but it is awesome for keeping your tendons/connective tissue/bones/ligaments strong and healthy.


3. Omega 3's and Turmeric are natural anti-inflammatories, and you want good fats like Omega 3's, coconut oil, and organic raw butter for a variety of other reasons.

4. Protein good. Vitamin D and Magnesium good. Make sure your Vit D level is up between 50-80.




Sep 28, 2010
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How much broth and how often for the most benefit?
by: Ann

Hi John,

Yep, I have hypermobility type of EDS (the one without stretchy skin). As I get stronger the symptoms become easier to manage, so I am hopeful. I just have to keep it up!

I took your suggestion and found some organic bones and made broth, it turned out pretty well!

Based on your experience, about how much broth should I consume and how often for the best results?

Thanks,

Ann


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Joshua Comments:

Hi Ann.

That's great if your experience is one of 'If I stay strong that keeps symptoms away'. That means many good things. Can elaborate if you want. Moral of the story? Stay strong.

That's a tough questions re: bone broth. Lots of variables including how long you simmer it, quality of ingredients, etc.

Basically, just make it a daily/weekly part of your diet, so you have a constant stream of nutrients into you.

You can take it in the form of a variety of different foods/recipes. And it might be good/smart to take a cup or two of it a day, with onions and cilantro and hot sauce (consume) etc.

But then again, it depends on how much you simmer it down. Sometime Kerri keeps adding water and boiling it off, leaving us with a dense, almost hard, cheese like block of gelatin. (simmer it down with some sage, or rosemary, or etc, and then it's basically a nutrient DENSE block of cheese or spread).



Jan 17, 2011
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Sesamoiditis
by: Antonis

Hi Ann,

I have read all the threads with lot of interests since i'm suffering the same problem for 7 months. I really need advice through your own expirience because i'm a dancing student and i need to get rid of this problem ASAP. It's been my first week out of school and i'm really anxious...

Jan 17, 2011
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Progress
by: Ann

The only real progress I've been able to make has been with the help of a physical therapist. Don't push yourself too hard too fast, that will make it worse. It's definitely trying, but patience is absolutely necessary to make progress. Good luck!!

Apr 28, 2011
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closure, finally!!
by: Ann

Hi Joshua,

I feel like I've reached a conclusion with my sesamoiditis thanks to a new podiatrist and I wanted to share it with you.

First off, the irritation in my big toe joints isn't sesamoiditis (maybe it was at some point? they're very close symptoms and treated the same way). It's rooted in hypermobility. My tendons are too loose, which causes my joint to grind and creates the irritation. Because of this I need to wear orthotics to take some stress off of the area.

I can't change my hypermobility, but I have found that strengthening my muscles (with the help of a physical therapist) helps a great deal, and I take glucosamine/chondroitin supplements which definitely help with the pain. That and I ice as necessary (no more heat! That was a bad idea!). The missing ingredient for me was definitely the strengthening exercises!!

Hypermobility is frustrating because I've learned that it isn't something that your doc will necessarily pick up on, especially if they're just treating the symptoms that you have at the moment. Finding a doctor who will describe big picture has been incredibly helpful for me because I have a better idea of how it effects my entire body, not just the issue that was causing me pain at the time. I feel that it gives me a better shot at avoiding issues in the future!

I started paying attention to my nutrition thanks to your site, and I'm glad that I did- supplements can help a great deal for someone with hypermobility, especially because I am more likely to develop osteoporosis in the long run. In addition to weight bearing exercise, I'm now careful to take calcium, magnesium, vitamin D, vitamin C, and omega 3 krill oil in addition to my multi and cosamin every day. I feel much better for it! Hardly ever get sick and my inflammation and muscle tightness are under control. Finally!!!

Thanks again for your help!!

Ann


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Joshua Comments:

Thanks for sharing Ann!

And good for you for continuing to investigate until you found the right answer, or enough answers, depending on how you want to look at it.

Increased muscle strength in the lower leg would help LOTS of people, as long story short, that's part of the problem over time.

If you want to reply and leave the name of the doctor, I'd be all for that, maybe a few more people will find him.





Jul 14, 2011
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SESAMOIDITIS
by: Anonymous

hi anne,
i have a similar problem that you struggled with not long ago. i am working on strengthening my foot and lower leg, but i was wondering what strengthening exercises you were doing?

Dec 19, 2011
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me too! - Sesamoiditis in both feet and Inflammation
by: Anonymous

hi!

i too have been diagnosed with sesamoiditis on both big toe joints. arghh! it hurts soooo much!

i did get one set of cortisone shots about 3 months ago and it worked beautifully...on one foot!!! the other foot hurts terribly. the relief was there for a short time, but after about 4 weeks the pain was back with vengeance

so, it sounds like i have some vitamins to take and some physical therapy to get, huh? what type of stretching exercises do you recommend?


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Joshua Comments:

Hi Anonymous.

Yes, you do have some supplements to take. Absolutely required for the body to work optimally.

I don't recommend any stretching, actually. Probably not a bad idea, but not my first choice of self care activities.

I would also see a really good podiatrist and see if a neuroma pad would help you. Google 'Morton's Neuroma'. Aside from the appointment, that's a $10 fix (well, maybe not a fix, but pretty damn effective and easy).

And learning How To Reduce Inflammation never hurt anybody!



Jan 05, 2012
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sesamoiditis in 13 year old son
by: concerned mom

Hi. My son, 13, started complaining about pain in his big toe joint last fall. He plays tennis, hockey and takes jiu jitsu, and they would start to hurt during these activities. Over time, we realized this was more than just a minor complaint. He has been wearing orthotics for a month, has gone to six sessions (so far) of physical therapy for ultra sound and stretching/strengthening, and had shots of cortizone on Tuesday. In addition, he has not participated in any sports or gym class for more than a month. I think we are doing all the right things. I am looking for other suggestions. He is not only suffering from the pain, he is really down about missing all of his sports. We are all anxious for him to be healed and back to normal.


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Joshua Comments:

Hi Concerned Mom.

Tell me in greater detail symptoms etc.





Jan 06, 2012
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PT is the way to go!!
by: Ann

Sorry it's been a while since my last post- I'm feeling MUCH better now thanks to a good physical therapist and commitment to a daily exercises, stretching, and massage- which were all tailored to my specific needs by my PT. Do yourself a favor and find a good podiatrist and physical therapist ( those that specialize in "sports injuries" are the best b/c their goal is to keep you active) and don't be afraid to ask questions!! Best of luck!
Ann

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Joshua Comments:

I would never direct anyone away from a GOOD practitioner that can actually produce results.


Jan 16, 2012
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Quick question about PT and Sesamoiditis
by: zark

Hi Ann!

Thank you so much for sharing all this useful information with all of us! I have had sesmoiditis in both of my feet for about 7 months now, and i am so fortunate to have found this page. I too have hypermobility, but I was diagnosed a while ago when I had patellar instability and failed to connect the dots.

After finding this page, I have purchased custom insoles to support my high arches, started doing my PT excerises (ended up stopping early due to my original podiatrist, who was awful), and will begin crossfriction massaging very soon.

My PT involves strengthening my arches, calves, ankles, and thighs. I was wondering if there were any excersises that you might have noticed were especially effective?

Also how long did it take you to notice any improvments? If you have any other advice that would be wonderful!

Thanks!



Apr 06, 2012
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Morton's Neuroma
by: Anonymous

Hi Joshua,

Also
from this link:
http://www.holisticlocal.com/forums/topics/view/765/start/20

Quote: "There are many mis-diagnosis of Mortons, mostly because the flexor hallicus longus tendon has come out of its groove. I have seen many mis-diagnosis.

The FHL tendon runs under the foot to all toes. There is a small groove at the base of each toe that the tendon fits into, when it misplaces, relatively easily, it usually goes back in easily also. Tight fitting shoes can cause it to displace. When it does displace, it causes pain and inflamation, and is often misdiagnosed as mortons. Manipulation of the toes can actually allieviate the problem. As I said, I have seen many diagnosed mortons, but were actually the displacement of the FHL tendon. Eliminated in 2 minutes."

See Link below on how to release
http://www.youtube.com/watch?v=U1qVge1TGIo

Also
I fully agree with the foot manipulation regarding the Morton's neuroma [mis] diagnosis to pop the FHL tendon back into place. Additionally, by working and releasing/stretching the hl muscle as well as the plantar muscles, the pressure on the nerves is released, and circulation is restored, and actual healing can occur. The nerves that have inflammed are calmed, and the pain and "wadded sock" feeling disappears. YEA! How do I KNOW this? I'm walking painlessly--and without said 'wadded up sock' in shoe! PS The podiatrist and MD wanted to do the cortisone injections, and ultimately REMOVE a nerve or two from the plantar surface of my foot. No thank you

Apr 07, 2012
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thanks for this info
by: Anonymous

Hi everyone,

This page is very helpful! Thank you, and especially for keeping it updated.

How active are the people with these conditions (sesamoiditis and/or hypermobile joints)? How much do you walk per day once you recover etc.?
I read that runners and dancer out there return to sports after a while.

I haven't been attentive to my left foot's sesamoiditis and kept jogging with pain which worsened it a great deal, and then my right foot became overworked from compensating and developed very sharp pain in the ball of the foot also, so much so that I couldn't even touch it without pain (I'm seeing a podiatrist and a foot ortho surgeon soon, for two opinions). I too have hypermobile joints.

For the past 8 days I have been:
- keeping my feet warm
- elevating and resting for most of my day
- massaging them, doing gentle stretching and strengthening exercises
- taking 600mg x 3 times per day for inflammation
- started taking all of the supplements listed above (I've been a vegetarian for 6 years now).
- when walking wearing dancer's metatarsal pads that apply no pressure to ball of foot
- when walking, then on outsides of my feet and in soft thick socks and sneakers


Today, I can already stand on both of my feet without pain (I tested this before I took my pain meds). I haven't dared walking normally though. Plan to get orthotic insoles and possibly do PT.

From all that I've read, tendon/joint injuries take MONTHS to heal, whether it be shoulder or ankle, etc.
Would you all agree?

Thanks again,
Polina





Apr 16, 2012
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Chilli Sauce Pain Relief of Sesamoiditis
by: Steve

Hi,

I have suffered from sesamoiditis for several years and also plantar facitis - it does seem that there are links between the causes of the two. I'm 45 and have played high impact sport since I was a child.

I play football (soccer) every week, swim and run and yes it hurts like hell - swimming is the worst - question is do you give in or carry on doing what you enjoy? Maybe I should rest up but can't bring myself to jack in sport.

I have had cortisone injections twice - I do not recommend them - they are extremely painful and their effects are questionable - the only benefit I seemed to get was from the local anaesthetic that was injected first - I had two days completely pain free until it wore off - bliss.

I have recently had x-rays and MRI scan on my left foot and will soon find out what the results are.

Ice and painkillers do not really touch it.

For short term pain relief my best solution was ( and I know this sounds stupid) hot chilli sauce rubbed into the area.

Maybe I will try glucosamine and green lipped mussel extract to see if these help..

Thanks



Apr 17, 2012
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Re: Steve
by: Anonymous

Hi Steve,
Speaking solely from my personal experience (I'm not a doctor, but have sesamoiditis in both feet) I would NOT continue with whatever is causing you pain until you figure out how to make it better. I continued with my running when my left foot was hurting. After a few years of "toughening it out," it got WAY worse. I now can no longer step on that foot normally and may need surgery. Don't ignore the injury thinking it will go away if you keep pounding on your foot/feet.

I would definitely look for a quality podiatrist who understands the mechanics of the foot well and what/why your foot hurts so she/he can at least make proper shoes for you so you can comfortably walk. I have been seeing David Levine in Frederick, MD. He makes custom orthotics, adjusts your shoes, etc. Even if you are not in the area maybe you can use him to find a quality podiatrist in your area.

I am a firm believer in staying active to stay healthy so I am determined to find a quality physical therapist in my area to focus on my feet.

Don't get discouraged. At least you can walk!



Jul 21, 2012
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Has anyone recovered successfully from Sesamoiditis?
by: Anonymous

Hi I just wondered if anyone can answer the above question.

I am really starting to get tired of the pain and lack of serious advice from the Doctor, Physio & Podotrist I have seen.

I am icing and wearing a gel sock, and stopped running 8 weeks ago.

TIM


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Joshua Comments:

What is 'the above question'?

There's lots up above this post.



Jul 22, 2012
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Update!
by: Zark

Hey, its zark from a months ago. Just came to say I was able to get back to 100% so don't give up!

I found out after doing a little research that the problem I had was that I had very weak transverse arches in my foot. I found a exercise called towel slides (http://www.livestrong.com/article/484859-how-to-strengthen-the-transverse-metetarsal-arch/) which, along with my other leg exercises got rid of the pain in about 2 weeks! Now 5 months later I am back to my old self. Good luck!


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Joshua Comments:

Go Zark!



Mar 30, 2013
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Tenosynovitis, pain, morton's neuroma, am I just unlucky
by: Karen

I was diagnosed with tenosynovitis in 1985 and had problems with my hands wrists forearms.In the nineties I had a troublesome ganglion removed from the back of my hand.

In 2004 I had an operation to remove a mortons neuroma removed from my right foot which was between the 2nd and 3rd metatarsal. At the time the doctor said it was extremely rare and very unlucky to get a neuroma in this area. In 2006 I had a 2nd neuroma in the left foot in exactly the same place.

The surgeon said once was rare twice was virtually unheard of. I have recently been diagnosed with tennis elbow in both arms and also have pain in my right shoulder.

The latest symptom is pain and weakness affecting my left ankle and bazaarly pain in my shins which feels strangely like my shin bones are cracked.

Could all these symptoms be related or am I just extremely unlucky?


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Joshua Comments:

Hi Karen.

Yes, all of these factors are related, absolutely.

Are you unlucky? Well, in the sense that you didn't get good help from your doctors, yes, you're unlucky.

1. Talk to a doctor about a 'neuroma pad' for your feet. I hear they instantly do wonders for morton's neuroma in the feet. Doesn't 'fix' anything, but can walk without pain etc. I'm not a big fan of inserts in general, but the neuroma pads seem to give a huge amount of benefit for a few bucks.

2. Your Pain Causing Dynamic has been increasing for years. Now you're feeling symptoms of the tendonitis dynamic all over.

Nutritional insufficiency, muscle tightness, connective tissue tightness, chronic inflammation, etc, have all been slowly increasing over time. And the injury of surgery makes things worse.

You're having those symtoms in the lower legs/feet because your structure isn't operating optimally. So compensation pattern sets in and gets worse...which is a fancy way of saying your'e hurting and going to hurt more because the body is trying to do a job that it can't do.

I'd suggest my Reversing Achilles Tendonitis ebook. You'll be able to apply what you learn to your shins and shoulder too.

You could also get Reversing Shin Splints and/or Reversing Shoulder Tendonitis but again, there's a lot of overlap.



-CONTINUED IN THE NEXT SECTION-

Mar 30, 2013
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Joshua replies to 'am I unlucky?'
by: The Tendonitis Expert

-CONTINUED FROM LAST SECTION-
Start with the Achilles ebook (because it deals with the entire lower leg) and then depending on what happens, you may or may not want the shoulder one. Just dealing with the lower leg and the nutrition may very well clear up the arms and shoulder.

Point being, by doing what there is to do for the lower legs, you'll be helping your entire body as well. Then you'll know if you actually have a shoulder/arm issue that needs specific help or not.

Regardless of whether you're unlucky or not, you can definitely reduce pain/problem that's happening in your body, either 100% satisfactorally close to it.


More questions, more answers.







Oct 25, 2013
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Sports injury, chronic inflammation PART 1
by: Jimmy

I just found this website today and have read all of the posts on this page - great information. The knowledge that others out there are battling similar issues helps tremendously. Particularly Ann's posts are great, as she kept the community informed during her evolution of therapy and rehab from Nov 2009 - May 2011. Thank you for that.

My situation is slightly different, as an injury was the onset of my issues. Three (3) months ago I suffered a “turf toe” (hyperextension) injury to my right big toe while playing soccer. It was pretty severe, as I felt the big toe joint pop out and back. I was able to limp off of the field and it wasn’t until the next day the swelling and pain really increased. Initial x-rays showed no signs of fracture, but based on the doctor’s assessment I did not get an MRI (In retrospect I wish I had). I was told to rest and stay off of it as much as possible. Since then I have done this the best I can, using crutches, easy biking (and I mean easy) or minimal walking to get around the majority of the time. I would not be overly concerned, but to this point I still cannot walk without an increase in swelling and a limp. I would have expected at least to be able to walk more normally by now. Running again seems months away at best. An MRI in week 8 indicated all ligaments were generally intact but that there was “edema” in the sesamoids.

I’ve seen 3 different doctors and a Physician’s Assistant (PA) to this point. The chronological order of appointments/events has been as follows:

JULY 22: INJURY
JULY 25, Doctor 1 (1st appt): X-RAYS - no fractures. ASSESMENT - probable partial tear of ligaments. TREATMENT - R.I.C.E., continue use of crutches and walking shoe (not boot) as necessary RECOVERY: 1-2 months minimum
AUG 12, Doctor 1 (2nd appt): more R.I.C.E.
SEP 5, Doctor 2: X-RAYS – confirmed no fractures. TREATMENT - recommended cortisone injection (I rejected this idea); suggested rest and felt pad under foot and switching to stiff shoe/hiking boots. RECOVERY – additional 12 weeks
SEP 25, Doctor 1 (3rd appt): I suggested getting an MRI, she agreed. RECOVERY - can sometimes take several months
SEP 26, MRI: RESULTS - All ligaments/etc generally intact. “Edema in the sesamoids”
OCT 7, PA 1: X-RAYS – No fractures. No additional comments made to MRI. Recommended a walking boot for to reduce inflammation and custom orthotics be made. I asked about topical anti-inflammatory use. PA says this is an option and prescribes it (again based on my recommendation). I deliberated for awhile about orthotics, but now have them on order.
OCT 7, Doctor 3 (1st appt): Recommended CT Scan to rule out any hairline fractures
OCT 7, CT SCAN
OCT 9, Doctor 3 (2nd appt): CT SCAN RESULTS – No fracture. No additional comments made to MRI. TREATMENT: Rest, I had to pry a Physical Therapy (PT) referral out of him. He specifically said “did not believe PT would help me” though. I disagree. RECOVERY: 3 additional months

Oct 25, 2013
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Sports injury, chronic inflammation, PART 2
by: Anonymous

For the past 3 weeks, I have been applying the topical anti-inflammatory 3-4 times a day as recommended (will do for 2 months minimum). I have tried different patterns for icing and heating, but am a loss at the intervals/frequency or which to do. I’ve always heard that heat is what you want following the acute phase of an injury to attempt to promote healing, but it seems like when I apply heat it increases the swelling. I will try to develop something more organized. Any thoughts on this?

I mentioned the orthodic insert in the timeline. It is supposed to be a custom orthodic to keep the pressure off of my big toe. I figure it's worth a shot. To this point I've tried a felt pad cut in a j-shape with not much success.

Sports or general activities are not even an option at this point as I still cannot walk normally without increase in swelling or inflammation. This SIGNIFICANTLY affects my daily activities. Though the swelling in my big toe is much less than from the original injury, it still swells and fluctuates from day to day. Naturally, the range of motion of my big toe is not the same as it used to be, and it needs some improvement if I’m going to be walking normally any time soon. Maybe strength exercises are what I need, but then it’s a delicate balance between trying not to aggravate the sesamoids. I have a physical therapy appt on Monday (Oct 28), so I’m hoping for the best.

Are there are any other known methods to help reduce inflammation? Does anyone have any experience with iontophoresis? Ultrasound? Acupuncture? Ann mentioned that she tried “electro-acupuncture, acupuncture, acupressure, deep tissue massage, and cupping to increase the circulation and control inflammation”, initially she thought with good results but said later mentioned the nightly heating seemed to make things worse. Did any of these other treatments help? Rest is obviously crucial, but at this point it seems impractical that it alone will do the job. Any advice or input would help. Thanks


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Joshua Comments:

Turf Toe can be bad news.

As you're experiencing, toes are no big deal until there's an injury....

So, confirm for me that there's no tendon/ligament tear. You stated 'generally intact'. Does that mean intact, or not intact?

Any problem with sesamoiditis or previous foot injury of any kind?



Oct 28, 2013
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Sports injury, turf toe injury but no ligament tear
by: Jimmy

Hey Joshua, thanks for the quick response. The MRI, taken 8 weeks after the injury, shows no tears. So, intact. If there were any tears at all, they had healed up by this point.

No previous toe injuries. Mild ankle sprains, but nothing severe.

To update. At my physical therapy appt today, we did phonophoresis. It seems like a guessing game to see if this will help.

Also, I was shown one simple stretch/exercise where I flex my foot forward but my toes backwards and hold for five seconds then do the opposite and flex my foot backwards and my toes forward and hold for five seconds. I repeat this 10 times, 2-3 times per day. Starting light, which I'm perfectly happy with since it seems to get irritated so easily. Im only icing (no heat) for time being with hopes to bring the swelling down.


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Joshua Comments:

Ice dip like crazy for the next 7 days, as high up the leg as possible.

See: Thumb Injury for partial description why.


Sure, do the stretches/exercises. Splint's not a bad idea for a short while to keep pressure off the joint.

Iontophoresis...guessing game indeed. It's basically a fancy high-tech expensive ibuprofen pill. Might help get you through the day, isn't going to fix anything.

That's good news the MRI shows no tears. Did it show inflammation in the joint? If so, how much?


1. Your toe popped out of joint? Yes? That's not awesome.

2. It went down and hyperextended or went up and back and hyperextended?

3. If it's not the turf toe tear, then it's joint issue. If it came out of joint, then ligaments stretched, probably very well have a 'bone bruise' really a 'joint/inner joint bruise'.

4. Describe in great detail the activity of the foot and toe before/during/after of/the injury event.

5. Ice dip like crazy for 7 days then let me know what's up with symptoms.



Oct 30, 2013
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Sports injury 1/2
by: Jimmy

I think ice dip sounds like a great idea. I will definitely start this today. As of right now I am icing whenever I get the opportunity or after any light activity (driving is considered light activity), but I will increase this.

When you say ice dip, should I try an ice bath for my foot for 10 minutes, then nothing for 10, and cycle for an hour or so, multiple times per day?

Or should the cycle be closer to 1 minute on and off with the ice bath? Which stimulates better circulation? Or is it arbitrary? It sounds like that with the thumb article, this individual tried to ice dip almost whenever possible. Given that it’s my big toe, an ice bath is not always feasible given my constraints at work, so at a minimum I will use an ice pack during these times.

Also, can you explain the logic as to why as high up the leg as possible? I think I understand why and I plan to do this, but I’d like to hear your logic.

I will continue to do the phonophoresis with the PT for the next couple of weeks to see how that goes, but I don’t anticipate much. I figure it’s worth a shot.

As of 25 October, I have put my foot in a walking boot whenever I move around but I still try to limit my movement. I’m glad you agree with this approach and I will continue to do so for the next couple of weeks to gauge the response.

The only explanation I’ve received on the MRI is that there is edema in the sesamoids. I was shown it on the MRI but exactly how much, I’m not sure as I have nothing to compare it to. None of the doctors had any particular comment as to whether it was a lot or a little.


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Joshua Comments:

Yeah, isn't it funny how doctors generally don't have much to say about it...

1. I'd just do as many 10-20 second ice dips as you can (give it at least a few minutes to warm up before the next one, or go hot/cold/hot/cold to help speed up circulatory turnover.


2. The thumb injury example was basically constantly in the ice water. That's because was trying to stop the constant charge of the acute inflammatory process.

You're past the acute stage, so the 10-20 second dips are fine.


3. You want as far jup the leg as possible to effect as much of the structure as possible. Muscles are involved, circulatory system is involved, etc. It's not JUST a problem at the joint (although it's mostly a problem at the joint).

Pain enhancing chemical floats and spreads through local tissue from the focal point. Dipping as high up the leg helps get all that out which equals less pain which equals faster movement back towards more optimal function.





Oct 30, 2013
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Sports injury 2/2
by: Jimmy

Detail of activity of foot: I am a very active and athletic person, so prior to the injury I was involved in multiple sports (soccer, rugby, hockey) and exercises (running, biking, hiking, etc). No issues at all.

The injury occurred when I was running full speed towards the ball during a soccer game. An opposing player arrived at the ball fractions of a second before I did and the end of my foot planted on the end of his foot after he had just kicked the ball.

This resulted in my toe big toe bending backwards and hyper extending. This is when I felt the pop in and out of the joint. There was no mistake, the joint definitely popped in and out. It hurt a great deal immediately (30 seconds – 1 minute) after the injury, but I was able to hobble off of the field.

It began to swell immediately, though not significantly until the next morning. It was very swollen and my range of motion in my toe was extremely limited due to the swelling. It was also very tender to the touch.

The next day I put myself on crutches and iced my foot as much as possible (apparently not enough). I would use the crutches the majority of the time, but the rest of the time I’d walk/hobble lightly on my foot.

The doctor had only prescribed the walking shoe (not boot), and she said this approach between the crutch and shoe was fine. If there was pain I generally tried not to walk and would use the crutches (I’d say 95-100% of the time I’d use crutches at work for the first month or two, but very little while at home as it was usually short distances less than 20 feet).

My activity has been fairly limited since then.

I will keep you updated as to how I progress. Looking forward to your response. Thank you.


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Joshua Comments:

4. The joint structure is inflammed, irritated, etc. Possibly there's some actual damage in there...if the joint dislocated then the ligaments have been stretched to some degree (not ideal).

So every step, every movement, etc, adds irritation to that already irritated dynamic. I'm only a fan of the boot in the short term, to reduce new irritation into the equation.

Along those lines try to avoid ANYTHING that causes pain. There's good pain and bad pain so you'll have to play with that, and you DO want to keep it moving (even just a little bit, keep it moving).





Mar 09, 2014
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Sesamoiditis plus some...
by: Sheena

Hello Joshua,
I apologize in advance if this post is super long, but I really would appreciate whatever advice you have, because at the moment I am living in Guatemala with no access to a doctor, or my clunky orthopedic shoes that I regret leaving back home.

I was diagnosed with sesamoiditis over a year ago. After struggling for eight months despite rest, icing, dancer's pads, being in a boot, crutches, contrast bathing, diet change, I was stuck, and so very, very frustrated because nothing seemed to help.

Finally I discovered barefoot running, which helped tremendously. By using the different technique of landing with a midfoot strike, I was able to strengthen my foot with out hurting it. Although I did have to transition very, very slowly. Also, even though I was able to run barefoot, I still had to be careful walking barefoot, which sounds weird, but it can really aggravate my foot. Anyway, my feet were strengthened to the point where I could go on long walks in normal shoes!! I was thrilled.

But I'm stuck again. I don't know what happened. Everything was great, I was able to go dancing and running and on long walks, but about 3 weeks ago I somehow reinjured it in a different way and I think it is related to my tendons and my big toe. The symptoms are slightly different bc the sesamoid bones don't actually hurt, but the sesamoid area on my right foot is indeed swollen.

My pain is worse in the morning when I get out of bed. The sesamoid area and toe feel super crampy/achy. When I start walking the stiffness in the sesamoid area goes away, but my toe still hurts in a way that is very hard to describe. Its like an overall discomfort of everything. The toe joint hurts sometimes, but it cracks like, allll the time. If I walk, I just have a lot of trouble using the first metatarsal and big toe.

It stings, aches, and just feels really stiff and unable to do what I need it to. When I first got my sesamoiditis checked out about a year ago, the doctor diagnosed me with hallux limitus, because my toe joint hurt sometimes.

But then another doctor, who is supposedly highly revered in the field, was really upset when I told him this because he said that I clearly didn't have hallux limitus bc my toe has a good range of motion. But when I walk it feels so stiff. I don't know quite how to describe it other than it feels like something is pulling my toes back. Like holding them in? Like making it tense. Ugh it feels horrible. I tried stretching it out and massaging, but I'm not really sure where else to turn.




Mar 10, 2014
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Joshua Replies to Sheena - Sesamoiditis Plus Some....
by: The Tendonitis Expert

Joshua Comments:

Hi Sheena.

Well, in general, you have some amount of one or both of the following things going on:

1. The joint is compressed and inflammed, and thus sort of grinding on itself, which causes more inflammation/pain, more muscle tightness which causes more compression, etc.

2. Too tight muscles and connective tisssue is pulling that toe into itself, which causes #1.


So.

A. How much do you ice dip/ice?

B. How much do you massage?

C. Where exactly do you massage?

D. Do you walk with a mid-foot strike?




May 02, 2014
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Sesamoiditis that Won't Go Away
by: Anonymous

I appreciate everyone's detailed posts and Joshua's responses on this site, it's been very informative.

Like most people who have posted, I have been suffering from sesamoiditis in my right foot since August 2013. The pain came on very suddenly after increasing my speed on the treadmill. I was in a walking boot for about 2 months. X-ray and MRI showed no fracture, only inflammation, and that I have a bipartate sesamoid, which is supposedly common in some people.

I am a 26-year old female, approx. 150 pounds and fairly active. However since this all began I have greatly reduced my activity. I have substituted running with pilates/biking.

Since getting out of the walking boot in about November 2013, the pain has been off and on. At first only running seemed to aggravate it, but now walking too much or hiking aggravates it, especially walking up/down hills. It doesn't seem to be getting any better. The orthopedic foot doctor gave me orthotics that has a cutout under the big toe. I wear them all day. When my foot is irritated/swollen, I wear a rubber dancer's pad.

I got a cortisone shot in April, and within a week the ball of my foot/big toe area was swollen again. I finally decided to try PT and will start this week.

I've read a lot that this can become a chronic issue, so I'm doing everything to try to avoid that with no luck so far. I'm going to see how PT goes, but am not super optimistic.

Can anyone recommend good vitamins/supplements that might help?

Also, I noticed a few people are in Maryland- can anyone recommend a good orthopaedic foot doctor and/or podiatrist in the DC metro area? If PT doesn't help I will want to get a second opinion.

I appreciate your responses.

Thanks,
M





May 26, 2014
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Sesamoiditis and osteoarthritis for 8 months in 30 year old
by: Marta

Hello,

First thank you for all this valuable information.

I am (was?) an ultimate Frisbee player. At the end of Sept 2013, I played in a weekend tournament, and at the end of the tournament I couldn't put any weight on the left ball of my foot. I rested it, had x-rays (showed stress fracture in second metatarsal), and waited. It slowly got better, and in mid-January, after building up my activities, I returned full force.

After 6 weeks, the pain returned gradually. I stopped all activity, and the pain kept getting worse over a few weeks. Feeling very frustrated, I asked for a bone scan which showed mild osteoarthritis and sesamoiditis in my big left toe.

It's been 4 months since I re-injured myself, and walking remains an issue. I've been wearing orthotics which sometimes make walking easier, and sometimes cause me pain. I feel best when I'm walking without any shoes on. I also strangely feel ok when running with shoes on, but walking with shoes on hurts. While the brief moments of running I've tried (e.g., running for the bus) don't hurt in the moment, they do seem to aggravate the issue the next day.

So I've tried orthotics (mixed results), ibuprofen (terrible stomach pain), lots of rest (helps but totally affects quality of life), heat (feels better in the moment), exercises to strengthen my arches (I have flat feet and bunions). Heat has made my foot feel better in the moment, and ice tends to make it feel bad (hard to describe in what way, but generally my body doesn't like cold), but maybe that's something I need to try again, I haven't done it consistently like you suggest.

The arthritis ("mild osteoarthritis") in my toe really scares me, because I'm only 30 and I worry about further degeneration. Also, I can't tell if the pain is from the arthritis or the sesamoiditis. At this point, I just want to walk without pain. Now my other foot is starting to bother me and I'm hoping it's just temporary discomfort from compensating, but I also noticed that the bunion on this foot appears to have gotten worse.

I was hopeful that my recovery would be the same as it was from Sept to Jan, but at this point the recovery has taken longer and I'm in a worse position. Feeling frustrated and helpless.

Any advice is extremely appreciated. Thank you.


-JOSHUA REPLIES IN NEXT SECTION-

May 27, 2014
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Joshua Replies to Marta - Sesamoiditis and osteoarthritis for 8 months in 30 year old
by: The Tendonitis Expert

-CONTINUED FROM LAST SECTIONS-

Hi Marta.

1. What orthotics are you using/trying? There's a little round circle pad you put on the ball of your foot, it's the only good 'orthotic' I've heard of.

I'm blanking on the name at the moment, perhaps a metatarsal pad.


2. So you had a stress fracture, and now joint issue.

Now your focus, like your doctors' is on your foot.

Problem is, your foot isn't the source of the problem. Meaning, fractures don't just happen for no reason.

Essentially, muscles aren't doing their job. There job is to absorb force. Muscles aren't doing it, so that force still has to go -somewhere-....point of fracture, for instance.

There is also almost certainly nutritional issue.


3. As a broad recommendation, I suggest you get 'The Plantar Fasciitis Treatment That Works' DVD and the Quick Start Companion ebook that comes with it, or at least, Reversing Achilles Tendonitis ebook (but not both).

Why? It covers the nutritional aspect. More importantly, it covers dealing with the SOURCE of the problem...which is that your lower leg is not functioning optimally...which is causing functional problems in the foot.


Orthotics and pads are neat and all, but they don't deal with the CAUSE. Dealing with the symptoms won't get you what you want, ultimately.


More questions, more answers.



Jun 02, 2014
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Daughter: 16 yr old ballet dancer, edema of sesamoid
by: Sandra

My daughter has been a ballet dancer for 13 yrs. She dances approx. 10-15 hours/wk, been en pointe over 4 yrs, summer intensives 5-6 hours/day.

In April, she began having pain in her right big toe after long rehearsals with many jumps. X-ray showed nothing. We treated it as a possible stress fracture, no weight bearing, no dancing, ice dipping (9 minutes 2x day), added calcium & vit D.

After 6 weeks, she had no pain walking or resting.

First ballet class she began slowly, but experienced significant pain. Dr suggested MRI, which indicated edema of sesamoid.

I'm confused, because her pain is in the inner side of phalange, not underneath near the ball of her foot! She is suppose to be leaving in 5 days for an 8 week ballet intensive.

She doesn't want to make it worse, but doesn't know if just having some pain while flexing her toe will be expected as she resumes ballet anyway, or if it will indicate further damage.

I am wondering if the pain she is having is truly indicating sesamoiditis? Nothing else was indicated on MRI. Orthopedic Dr suggested taping the toe with slight downward flex.

Does the pain I'm describing sound like sesamoiditis?



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Joshua Comments:

Hi Sandra.

Where one feels pain isn't necessarily the spot where the problem, or the source of the problem, is.

So it makes sense there's inflammation etc at the sesamoid, resulting in toe pain.

Which really means that muscles aren't working optimally somewhere, so they're not absorbing force like they're supposed to. And all that force ahs to go somewhere.....somewhere that isn't designed to withstand that force.

-CONTINUED IN NEXT SECTION-

Jun 03, 2014
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Sesamoiditis diagnosis over 13 years ago
by: Anonymous

I was diagnosed with sesamoiditis over 13 years ago and over them years I have had several cortisone injections in both feet. I have also had several different types of orthotics.

I am now 41 years old and recently had back surgery also. (Who said life begins at 40!)

I have suffered severly over the past year and after several blood tests I am still none the wiser. One doctor said to me 6 weeks ago that I have gout then the next said that two blood levels,that are concurrent with gout, showed up as normal.

Today I had an ultrasound guided injection which the consultant said that I had erosion in the joint and that he was referring me to a Rheumatology specialist.

I am sat here in excruciating pain and I am very worried.

Is it possible I could have been wrongly diagnosed all them years ago, that it could have been gout and it has possibly caused irreversible damage to the joint?

Any help much appreciated.

Peter


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Joshua Comments:

Hi Peter.

Yeah, Corticosteroid Injections don't fix anything, unfortunately.


"Is it possible I could have been wrongly diagnosed all them years ago," Yes.

" that it could have been gout"
Maybe, but doesn't sound like it from what you've said.

"and it has possibly caused irreversible damage to the joint?"

Maybe. And, 'it depends'. 'Irreversible damage' is really relative, depending on who you talk to.


Let's investigate:

1. What is your vitamin D level. You just had several blood tests, PLEASE tell me that one of your doctors included a Vit D level in there.


2. Why specifically does that doctor think that there's 'erosion'? Because of what s/he saw on ultrasound? Or? If on ultrasound, did s/he print pictures of it etc?


3. What does your overall diet look like? Do you supplement with any nutritional supplements?


4. It's likely the long term foot issue caused the back problem. Force not absorbed by the lower leg transfers up the body. That's what caused mine disc rupture (as far as I know).

See my recommendation of the ARPwave System (follow the link to that page) in my response to Sandra (which should be very close to this post).


5. Did the orthotics etc help a little, help a lot, help not at all?


6. Any other interesting/helpful information/details.






Jun 03, 2014
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Joshua Replies to Sandra - Daughter: 16 yr old ballet dancer, edema of sesamoid
by: The Tendonitis Expert

-CONTINUED FROM LAST SECTION-



It's safe to say, unless you deal with the CAUSE of the inflamamtion at the sesamoid (area), then an intensive ballet class/training is a bad idea. Maybe not, but it's predictable.

It may be or may not be considered pricey, but the fast fix is The ARPwave System. It's rather intense, but I have zero doubt that it can get her lower leg and food working optimally again .

5 days before leaving....I'm always optimistic but I imagine it's a bad idea at this point. It sounds like she's wise enough to know that hurting her toe/foot even more is a bad idea in the short and long run...and that sounds wise to me.

Work with the ARPwave, and she can do an intensive the next time one rolls around (or travel for it, or however that works best.).


Point being, if she is serious about ballet, she MUST master how to keep her already-not-surviving-ballet-well foot in working shape. So many have to quit it forever due to injury..they didn't have tne know how and or the tools to fix injury, to stop injury from getting worse, and/or to stay injury free.

Perhaps it's just a pain she can work through, and she'll have to make that choice. I admit I'm biased, as I work with the people that tried to tough it out only to end up worse off than they were before.

I can say for sure that rest and time off isn't going to fix the problem...she's just start back up in a month or 6 months or a year and before too long, the same pain/problem will wave hello.


1. Have your daughter read this page: Process of Inflammation


2. Switch to ice dipping as described on the page: How To Reduce Inflammation. A 9 minute ice dip is a waste of about 8.5 minutes.


3. What is your daughter's Vitamin D level? How much is she supplementing with? (And what is yours, while you're at it...Vit D is a soap box I'm happy to get on, as, for instance, adequate levels decrease the incidence of cancer by 83%).


More questions, more answers.





Jun 04, 2014
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16 yr old Ballet dancer, edema of sesamoid
by: Sandra

Hi Joshua, thank you for your response and suggestions. My daughter & I read the information about the process of inflammation and the pain causing dynamic, as well as much more on this site. Your information does make a lot of sense!

She began the ice dipping as you suggest, and ice massage. For now, she is taking 2000 IU vit D (I'm on 1000 IU) We live in Texas (the original sunshine state!) She's also supplementing magnesium, a basic multi-vit, and eats more nutritiously than your average 16 year old.

I am almost convinced her pain is some form of tendonitis. 7 weeks of rest, with no weight bearing did not make much difference in pain when she resumed ballet.

The arpwave system sounds intriquing, but also pricey. I will keep it in mind as an option, but hope we are able to treat with the suggestions from this site, and corrective technique in her ballet.

Her instructor suspects possibly tight calves or pulling back while en pointe. Thank you for your informative site! I will be referring to it as we continue to help her through this issue.


----


Joshua Comments:

"Her instructor suspects possibly tight calves "

Her instructor is 100% correct. Add the Soleus into that mix...and anything else in there that's too tight.


Sunshine is only good if you're in it, not using sunscreen or clothes, not showering afterwards, and during the right time of year/latitude (depends on if you're north or south texas.

So those Vit D doses may be enough. Overall research says, "not".


Yeah...Rest is not a cure. And there's a big difference between Rest and Relaxation.


Good luck, and keep me updated!




Jun 05, 2014
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Sesamoiditis diagnosis over 13 years ago
by: Peter

Thanks for your reply Joshua.

In reply to your 6 points:

1- I rang up the doctors today and out of 3 blood tests, there was none done for vitamin D.

2- He said to me there was erosion in the joint and that was information from what he saw in the ultrasound scan. I never saw the screen and he never gave me any pictures. They have been forwarded to an Orthapaedic consultant of whom I have an appointment with next Friday. At this point he gave me the injection.

3- I like to think my eating habits are pretty healthy, I don't take any extra supplements but I have lacked doing physical exercise due to the back/foot issues.

4- I have been seeing a chiropractor frequently over the years but I DID have a very heavy job which has took it's toll on my back when I injured it last April when using a sledgehammer.

5- the orthotics did seem to help but wether that was mind over matter remains to be seen. When you are told by a specialist you have a condition, you then look at managing that condition as best you can and that's what I thought I had done until it was causing me more and more problems over the past year. I have not had the orthotics in since I was told it was gout, (5 weeks ago), and don't seem to have any reaction from my right foot yet. The doctor who did the ultrasound said there was no signs of gout.

6- On the blood test results, the second doctor sent me for them again as two of the levels that are related to gout were normal,(inflammatory levels I think), but the acid level was only slightly higher than normal.

Is it possible the inflammatory levels were normal as I was taking medication at the time. (Naproxen) The only other thing I can share from my thoughts are is it possible that there is gout within the joint caused by acid build up which could be due to being less active over the past year?

Your time is much appreciated and a great site you have!

----


Joshua Comments:

You see a the doctor this friday (2 days from now)?

Let me know what s/he says and we'll continue.

RE: gout, you either have it our you don't...but you can certainly have inflammation and irritation and grinding and what not in any particular joint.

Do you know what happened to your back, specifically? Does it still hurt?



Oct 18, 2014
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Sesamoiditis not healing (turf toe Sports injury)
by: Sofia

Hello !

Found this website after so many researches and I'm very happy about it. Glad to finally find people with similar injury.

I've been injured (turf toe) 4 months ago while playing football.

My doc (a sports doc) said it was just a contusion. Gave me Anti-inflammatory gel to apply during a week.

Three weeks later it was still hurting, I couldn't even put the foot flat on the ground nor touch my big toe. So decided to go see another doc who sent me to an orthopedic surgeon.

I first had a radio : nothing. So he told me to wait 2 more weeks (as it had improved a little) and to have an MRI if it'd still be hurting. It did. Had an MRI 6 weeks later. It showed nothing except a probable inflammation of the sesamoid. So the orthopedic suggested I have a scintigraphy, and to go see a podiatrist to get orthotic inserts to offload the sesamoid meanwhile.

The scintigraphy confirmed the inflammation.

I felt an improvement since I got the inserts, like if the circulation in the big toe was getting better (I've been walking on the left of the foot for all those months)..

so I now have to wait 4 more months to still give a chance to it to heal by itself as the only other treatment would be a surgery according to my orthopedic..

He proposed me to do injections for the time being. I accepted to do one (3 days ago) , and today it feels way better. I can put my foot on the ground but still can't walk properly, but I guess it won't last...

I'm a really sporty person and so since my childhood. I had many injuries. Most of it where sprains.. I've read all the posts on here and it made wonder if I haven't some kind of hyper mobility (but a really light one).. or it's just that my tendons are weak. I also have a chronic inflammation of the patellar tendon..

Anyway, many on here suggested PT, and I wonder if it would be effective in my case. As a sport lover, I'm tired of this inactivity and I really hope this won't turn into a chronic thing.. It's been "only" 4 months but I've reached a point where all I want is be able to walk normally without any pain..


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Joshua Comments:

Hi Sofia.

I'm biased, I work with the people that PT fails, so I can't really say if Physical Therapy will help.

Give it a try, see what happens. Who knows, it just might help.

Having said that, Turf Toe is a tough scenario because there's all of the factors of tendonitis -and- a lot of joint involvement.

Correct inserts tend to help alot with sesamoiditis. I'm generally against inserts but these often really actually help.


Tendonitis is quick to recover if the right self care is applied. Turf toe is generally slower because there's joint/joint capsule inflammation and potentially bruising of the joint lining, which is PAINFUL and slow to get back to optimal.

A muscle contusion is no big deal. But bone or joint bruising, ouch.

That's part of sesamoiditis...joint bone/lining bruise. Super painful. And of course all your weight is on it.

DEFINITELY don't go running etc if you feel better after a corticosteroid injection. Less pain in no way equates to 'injury free'. You can/will make it worse if you push it when you/it can't feel what's happening in there.

That's good news the MRI didn't show anything but inflammation (presuming it's a complete and accurate picture).


IMPORTANT: If you have sesamoiditis/turf toe now, it's a safe bet that it WILL turn into a chronic thing.

Aaaaaand, it's important to understand the Pain Causing Dynamic.

I am saying the above to scare you (and because it's true), but mostly to motivate you to do what you need to do to get back on your feet.

So. What are you doing for self care to make it better?




Oct 27, 2014
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Sesamoiditis not healing (turf toe Sports injury)
by: Sofia

First, thank you very much for you answer, I've been waiting impatiently for it.

I was failing to understand how "just" an inflammation would/could take so long to heal. Thanks, it's all clear now.

I may feel better, but don't worry I'm still far from being able to run "normally". Inserts helped me a bit, but I've noticed it's even better since I've got myself new trainers. They (almost) make me feel like I've totally healed, and I'm happy about it cause every step was starting to be a real pain for my knee.

I tried the icing (and it's the first thing I did the day I got injured) but I hardly manage to support it, like my big toe is too sensible.. so I stopped. Instead I started to do self massage with black seed oil every night. And I really feel improvement when I do that. That's why I thought even more about PT..

As for the Pain Causing Dynamic, I'm cognizient of this and I would have liked that my doctors look at the biggest picture/problem if there is one.. but why none of them did?.. so I thought maybe it's just me..

Dunno if it could be related but I had a muscle tear in the leg few weeks before this injury, it was not completely healed when the turf toe happened. Also, in my childhood, I had an Osgood–Schlatter disease. And apparently, it turned into a chronic inflammation (knee) that still bother me today.. (this is in the other leg tho).

So I thought maybe I have a problem with my quadriceps.. (besides that I've kinda over trained this year) or even with my legs alignment, but then again I keep thinking how would have no one noticed that?


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Joshua Comments:

That makes total sense. The lower leg structures control the foot and the function of the foot. If they're not working well, the foot's not working well.

The job of muscles is to absorb force. If they can't, that force has to go somewhere. And that somewhere tends to be somewhere that isn't designed to take that much force.

Thus, rip and tear injury, and/or joint 'grinding itself to inflammation and pain', and/or any other version of pain and problem.

And of course, when the foot/lower leg isn't working right, force also transfers up the leg.....like to the knee.


Definitely keep up the massaging of the entire lower leg. The better you can make it work, the better.

It might be worth getting my Reversing Achilles Tendonitis Ebook. It deals with nutrition and the lower leg, and you can apply everything in it to the foot/toe joint(s) also.






Sep 24, 2015
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Bruised sesamoid
by: Anne

Hi,
I stumbled accross this page which I found very interesting and would like to know what recommendations you may have for me. What I have has not been labelled as sesamoiditis by any doctor I have seen so far, but it sounds like it might be that, or a similar condition.

I started having pain in my big toe almost 5 months ago while wearing high heels at work (I used to wear them almost all the time at work), the pain gradually increased over the next three days and I stopped wearing the heels and could never wear them again since then. Two days before the pain started, I dropped a suitcase on my big toe when coming back from vacation, but the next day I was ok when walking with flat shoes, and there was no swelling, so I don't know if it's related.

I don't feel a lot of pain when walking in flat shoes if I limit my movement during the day (but I do experience pain when I walk a lot and at the end of the day). It is however really painful in the big toe area when putting pressure in the front of the foot (this is why high heels or standing on my toes is impossible).

The first doctor I saw asked for an x-ray, which showed no fracture, so he told me to patient and not to walk too much on my foot. The second one said the same thing. Then I did physio, but we stopped because it made the pain worse. I then saw another doctor and asked for an MRI. The doctor agreed to a second x-ray (negative again) and an MRI. The MRI showed no fracture, but a showed a synovitis of the first metatarsophalangeal joint, associated with a bruised lateral sesamoid and a tear of the lateral side of the inter-sesamoidean ligament. It also mentioned a degenerative aspect of the plantar plate of the first MTP.

Following the MRI, I saw a first orthopedic surgeon that suggested cortisone infiltration, and "maybe orthotics"... I was not convinced about the cortisone so I saw a second orthopedic surgeon and he was against the cortisone and said orthotics sounded a bit excessive, and that I should just be patient - he however ended up suggesting that I wear a little foam 'donut' under the ball of the foot to releive the pressure on the sesamoid bones. This was two days ago so I don't know yet if it will help. None of them said we needed a follow-up appointment.

I am a bit discouraged since I am getting different answers from different people, which are all vague, and I don't know what to do. I don't even really understand what I have. The stories I read regarding injuries in this area are also not encouraging at all.

Thank you in advance for your feedback!


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Joshua Comments:

Hi Anne.

It sounds like you essentially have a bone bruise (which is basically the same for any of those little structures in there).

And the tear is going to be painful/problematic. Too small to do surgery on, probably (and that would cause all sorts of pain/problem too).

Bone bruises can take a long time to recover, especially when 'poking' them every time you take a step. And torn ligament, same thing.

Were I you I would go crazy with the ice dipping and ice massage as per Learn How To Reduce Inflammation

There's not a lot to 'do' for the injury other than focus on decreasing healing/recovery time (which you can do substantially).

It wouldn't hurt to do some work on the structures on the back of the lower legs, as they have been problematically shortened by high heel use.




** Public Service Announcement: High heels are bad for feet and lower leg structures.


Mar 28, 2016
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sesamoiditis, Hullux limitus... not sure. Part 1
by: Stacey

Hi Joshua

My names Stacey and I am a 24 year old student. I live in Scotland and would like to say I'm a fit and active young woman, but that's a thing of the past right now.

When I was 20 I stubbed my big toe (right foot) very very hard against a piece of hatd metal..right underneath the head of the 1MTP joint. It was very bruised not black/blue - doc said I had a bad bone bruise. That was painful for about 6 months and ever since then I had trouble with it on and off. I can't remember how I treated it, I did rest and took a few weeks off work.

Anyway I visited a physio around that time who was great and gave me stretching exercises for my foot and stuff and also 'electric frequency' or something to reduce inflammation.

After another 6 months I was fed up of the pain coming and going (flared after exercise mainly or certain shoes) so I went to see a podiatrist. Diagnosed me with Halix limitus and flexible flat feet - got custom orthotics. I still use them and without them I know I'd be a lot worse off. They help take the pressure off the 1MTP joint.

Fast forward to now. 4 years later. My big toe (Right foot) has flared up since December and is not going down..This has led my mind to hypothesise that I maybe have gout or a sesamoid fracture that's never healed. Also!! I hurt my left foot a couple months ago near the 5th metatarsal and whilst that's healed and all good I think I was putting more pressure on my 1MTP area in the left foot. Now my left big toe has similar pain to my right, albeit not as "swollen" or "bigger" in appearance almost like a bunion but I've been told I don't have bunions.

Told my podiatrist about it she says it's losing motion the same as the right one. Funny thing is I went to an orthopeadic surgeon last year who took an xray of my right big toe and said it's a healthy mobile joint, but I do have flexibility there.

I'm just really pretty down about the whole thing because sometimes I wake up with burning pain in my toes which is relieved by massage, and I get pain under the ball area of the toe after walking maybe more than 10 minutes.


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Joshua Comments:

Hi Stacey.

Maybe you have Gout or whatever, but you definitely have the long term/predictable effects of a Pain Causing Dynamic.

Meaning, you hurt your toe/toe joint, bruised the bone/joint, and that pain/problem kicked in (no pun intended) a mechanism that made things hurt, made structures tighten up, and kep that pain and tigtness in place and progressive.

The right foot (and everything else) had to adapt/adjust to compensate.

And it all goes downhill from there.

See the How To Reduce Inflammation page (link in this thread) and start ice dipping your feet and lower legs like a crazy person.

See: Bone Bruise


Bone bruises in ankle/feet/toe is tough because you can't really stay off them to redece new irritation to an already irritated dynamic.

But you're going to need to knock inflammation down, and keep knocking it down, to give the structures a chance to recover.

More questions, more answers.



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