u/moltplop

Healing while still having some pain?

Did anyone progressively heal over time even as they had some pain?

I’ve been in a boot for 12 weeks now and have no pain sometimes, some pain sometimes. It really feels random and intermittent, not activity dependent (for example, I walked 5000 steps in boot Tuesday and it felt fine that day and the next. I sat around all day Thursday on Zooms and it acted up a bit more Friday).

I have tried some very short shoe trials and had some delayed pain after.

I have met with two PTs and they have differing opinions on pain. One says I will not leave the boot until I’m entirely pain free for 5-7 days, while continuing to do some ankle mobility work and basic foot work (toe yoga, mostly).

The other says that at this point, as long as the pain is below 3-4, I need to get back in shoes so if I’m progressing with shoe trials and the pain doesn’t go above 3-4, I need to keep going. She also suggests doing more PT exercises, like short foot and pressing my big toe down with a band trying to pull it up to start loading the toe a bit. She also wants me standing in soft Birkenstocks (not walking) for several minutes a day, like in the shower, to start getting my foot used to load on the foot. None of these things hurt WHILE doing them, though I continue to have intermittent weird pain at random times while walking in boot, and she thinks that’s just going to be what it is.

Did anyone progress in a positive direction without getting pain down to almost zero after initial immobilization period?

I have severe sesamoiditis, multiple opinions say no fractures despite bone marrow edema.

I’m in a boot to see if I can heal my double injured sesamoids and get back to pain free.

It’s been two weeks now and I have not needed to modify the boot to keep pain below a 2 while walking mostly as needed. While walking, I get somewhere between 0-1 on the pain scale with some almost indiscernible tightness at rest (sometimes I have to check which foot I’m doing something on out of the boot because there’s no pain, so I’m like oops, which one is the injured foot?).

Before this, I had a very focal pain on the lateral edge of the joint. It pinched when walking before turning into a sort of tugging then pinpoint bruise feeling. That was my only symptom. The sesamoids were only directly painful sometimes like when the whole foot was swollen.

Now, in the boot, at worst I feel what I’d call general pressure in the area, but as much in the rest of the forefoot as the sesamoid area.

I’m probably wayyyyy overthinking this, and should say hey, if it ain’t broke! But I can’t help but wonder if I’m making a mistake by not modifying the boot with a cut out insole? Id really prefer not to, since I tried and failed at dancer pads before as the painful area is just too far into the center of my foot so then the 1st MTP just fell into the dancer pad hole, rendering it useless for lifting the joint. I worry that playing around with the insole I have in there might create new issues? So I just have a thick diabetic insole in there now and it’s going well, I assume?!

Should I just keep using the boot with the thick full insole until pain becomes like a 1-2 constantly or over a 2?

Please please please send recs for doctors, PTs, orthotics makers, or other specialists in the DMV area for help.

I’ve been to three orthopedic surgeons who seem to think bone marrow edema and arthritis heals in 6 weeks with a boot (spoiler it didn’t), which makes me think all they know is the surgery side. My issues are too complicated for surgery so I’m pretty anxious to a find a doc who will do more diagnostics to ensure where the pain is coming from, help with actual offloading, direct me to other non-surgical options etc and then maybe know enough to eventually do surgery if needed.

For PTs, I haven’t been able to find ANYONE who knows it or if they do “know” sesamoiditis during the phone consult they suggest I start doing calf raises or come in for barefoot gait analysis… so I’m like yeah, you don’t know.

Orthopedist? Regenerative medicine docs?

Any help you were able to get in this area! Please!!

What surgeon is offering:

surgeon is willing to remove a sesamoid. He believes my sesamoid adjacent pain is caused by cartilage rubbing the bone. However, without a fracture, this seems like a crapshoot but I’m not a doctor. My first doctor many months ago also said he’d remove the bone. He said this before conservative attempts, saying I’m welcome to try but he’d remove the bone closest to the painful area after 6-8 months if I don’t improve.

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MRI and symptoms:

MRI show a lot going on with the joint, including both sesamoids involved via confirmed bone marrow edema, long-term bone hardening, and cartilage wear and tear, and general edema and inflamed bursa around the first and second toe.

I cannot reliably identify one of the sesamoids as the pain generator, despite both having MRI changes. Pain is closer to one sesamoid than the other, though not showing more MRI findings than the other.

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What I tried:

I was unable to reduce pain more than keeping it from being very high pain by using stiff shoes. Swelling and pain near the sesamoid, never got to no pain and did not respond to, dancer pads, holes in insoles, taping which helped the most when walking but did not stop the inflammation and pain on touch, variety of shoes. Orthotics, though does not hurt on every step when taping. Always hurts to touch. Pain never above a 4, never below a 1.

I was unable to go non-weight bearing because I have very bad sciatica, PF, and other issues on the other side. Sitting for prolonged periods of time made all of that much worse. I had to give up nonweightbearing after one week.

What I have not tried:

Cortisone injection — I have been discouraged bc of what this sub and some sources say about cortisone shots but wonder if this would help “prove” where the pain is

Physical Therapy — I have been hoping that highly reduced steps over time would improve. I do not exercise or walk more than I need to. I have been scared to do PT and cause irreversible damage if my foot is not ready for PT

Extended non weight bearing at the expense of the rest of my body — I only tried non weight bearing for one week as my body rebelled strongly to this with immediate issues in other leg and then circulation issues and back pain when in a wheelchair for a week

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Everyone says this can take 1-3 years to start healing, but that seems like only if the initial calm down phase happened. That never happened for me. Has anyone healed anyway?

Other doctors I have seen have just said limit walking and do PT but they seemed less knowledgeable.

I wish I just had a fractured bone with AVN, knowing that’s what was causing my pain.

Hi everyone,

Not looking for advice about healing the injury, since I’ve read like every post on here, but looking to hear how disabled you are or were before you fully healed (or mostly healed). I don’t mean during the super acute first few weeks or months but long-term. If you’re now having chronic Sesamoid issues.

What type of sesamoid injury do/did you have and how functional were you day-to-day when it was not resolved but not brand new or during flares. Are/were you able to do chores? Work? Grocery shop? Use a stationary bike or rower? Do daily tasks but not the workouts you enjoy? Have you been unable to walk without a limp or for more than to move around your house for years?

I know long haul is substantial quality of life and depressing but what does that look like on a day to day?

Based on what you see here what’s the typical impact on long termers’ functionality?

I know people are more likely to post if the title resonates with them and it’s dire but please consider replying if your journey sucks/sucked but you have still been mostly functional too.