Sesamoiditis in both feet and Inflammation

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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.

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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Please reply using the comment link below. Do not submit a new submission to answer/reply, it's too hard for me to find where it's supposed to go.

And, comments have a 3,000 character limit so you may have to comment twice.
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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com

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Sesamoiditis in both feet and Inflammation

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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!

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Sesamoiditis in both feet and Inflammation

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Sesamoiditis in both feet and Inflammation