I'm writing to find out information about sesamoid fractures and pain in other parts of the foot/ankle. My husband had been diagnosed with sesamoiditis approximately a year and a half ago. In the mean time, I had my own foot issues and joined this board. After orthotics and painful cortisone injections, my husband sought a second opinion. New x-rays revealed his sesamoid on his left foot was fractured. His new pod made new orthotics which my husband started wearing two weeks ago. Now his ankle hurts and is swollen, though he had no injury to the site. My husband is trying to avoid surgery, though I was hoping my own experience (7 weeks post-op double bunionectomy on right foot) would encourage him that surgery may be helpful. From reading various threads I have noticed that often people have tendon issues along with bone/structural issues, which is my concern regarding my husband's new symptom. I have also read that orthotics can have their own side effects due to making the feet/body walk in a new way. I advised him to see his doctor this week, but he is a wee bit stubborn.
I would appreciate any thoughts or ideas about his foot issues. Thanks.
Hi Jane, the research I have done on the sesamoids and injuries to them, is usually a hard diagnosis to make as those two bones are very very small and a fracture sometimes doesn't show up. Mostly what I have read as far as treatment goes is NWB on the particlar foot for a while...also casting from anywhere between 6 - 8 weeks. But, even then, you might still need surgery. I know for me, the first doc I went to with my feet problems was an ortho doc. They immediately said it was my sesamoids giving me all the pain. They only told me to use metatarsal pads behind the sesamoids and they gave me cortisone injections. They would not discuss surgery at all. I also got steroid pills which made me very sick. So, when the pain continued, I went to another doctor who told me it was the bunion and I had the surgery. My doctor told me that the bunion surgery would relieve the sesamoid pain...but I still have pain in that area and I am almost 6 months post op from the surgery. I'm not sure what the deal is.
I have read that sesamoid surgery can cause issues with how you walk since the sesamoids act as a pulley behind the tendon that helps with the movement of the toe. I have read on here that some people have had great sucess with this surgery. I guess like anything else...do LOTS of research.
My husband also has flat feet. If you have a fractured sesamoid, would the aim of surgery be to remove it altogether? Chic43, I remember my pod was very pleased when he viewed my pre-op x-rays and saw that my sesamoids were not damaged. I would guess that walking on a foot distorted by bunions puts pressure on the sesamoids. Feet are so tricky. I never realized, until now of course, how important comfortable feet are to one's general well being. My husband has an appointment with his new pod in two weeks. I'm gently nagging him to move the appt. up. If his ankle continues to hurt, I'm sure the pain will nag better than I. Thanks for both of your imput.
Sometimes a surgeon will attempt to repair the sesamoid, but because it's so tiny, and often broken into more than two pieces, repair surgery has a high failure rate. Removing them is the more common procedure, if conservative measures don't resolve the problem.
Even with very conservative measures, sometimes a fractured sesamoid won't heal and the bone may actually "die"...from what I understand you end up having to remove it. I haven't had it done myself and was really relieved when my doc told me that I didn't have a sesamoid issue. But, there are a few and rare success stories from having them removed. When you have a bunion it causes lots of things to go out of alignment, including the sesamoid bones...pushing them out of their normal track will cause pain. And, depending on how long you've had the bunion, it may take a while for sesamoid pain to reduce as they are trying to get accustomed to their rightful place after being out so long.
Jan 12, 2006 - Saw DR, had X-Rrays, MRI-
Results were - "Sesmoiditis vs fractured Sesmoid". Not conclusive, but wow, painful.!
Today, saw DR again. Did X-rays again and compared to old ones and Immediately said "Thats not good". Said just on the X-rays, it appears one of the Sesamoids is either fractured or possibly dying and is more damaged then first set of Rays. ( Its the inner Sessmoid)
Ordered a MRI for next week and I return on July 18th for results.
He said based on just the X-rays, he believes the MRI will conclude that the Sessmoid is dead, or fractured badly.
He said he recommends taking it out as he has seen my mobility decline over the 18 months and we have excercised all concervative treatments.
I will post updates as I go.
Last edited by rjs2008; 08-10-2008 at 06:16 PM.
Reason: unnecessary quote
Thank you for the information. My husband has seen his new pod two times so far. He has another appt. in one week. His old pod never ordered a MRI. Apparently his new x-rays for the new pod showed a fracture in one sesamoid bone. His pain has steadily increased this past year. He works for a Public Works dept. and is frequently on his feet. He has been given a cortisone injection 3x's by his old pod, which were extremely painful and did not result in any pain reduction. I appreciate your sharing of information.
Today my husband came inside from mowing the yard and said "I think I need the operation". He is going to his new pod this week. I will ask him to talk to his doctor about an MRI, though the x-ray did indicate a sesamoid fracture. My husband never takes a sick day, and the thought of being out of work for weeks is overwhelming him (though he has seen me out of work for six weeks). The good news is he has plenty of sick time. Thanks again for all your feedback.
My husband finally saw his pod today. The doctor said my husband has tendonitis in his ankle area. He is giving him a perscription for an anti-inflamatory and is sending him home with, and I quote my husband "storm troopers boot". He told my husband to stay off his foot as much as possible this weekend and he will see the doctor again on Tuesday. Here are the things I'm grateful for; I'm mobile again and can be my husband's nurse, that his bad foot and my bad foot are on the outside side when we are in bed, and that I have had this board to learn and get support from. Is it possible his tendonitis is a result of the sesamoid fracture? Thanks again for the feedback.
Actually I don't mind taking care of him because he was a good nurse to me in my time of need (and I wasn't convinced pre-surgery that he would do so well). Of course he won't be a model patient. His doctor told him to stay off of the foot for a week. My husband said he couldn't because of work. I reminded my husband that I ended up NWB for five days because I did too much. I guess one has to have their own painful experience to learn the lesson. He is grilling dinner tonight, standing in the boot............
The doctor told him to have a shoe of equal height. He is wearing a sneaker, which to me doesn't seem raised enough, but he said the doctor said it would work. My husband sees the doctor on Tuesday. I would guess if he feels a lot better, he will put off surgery. My husband wants to have surgery in the winter due to lessened work load. I can't imagine why he would want to go out in a boot (the surgical kind) in February in Maine. I don't think he realizes how slow recovery really is. I've recovered quite well, but the first six weeks were made up of not driving, using a walker for three weeks, a setback etc. I guess his memory is worse than mine. Time will tell.