No boot/no NWB?? - for mild symptoms and unmild MRI
I apologize for two posts in two days! I'm just trying to make some decisions.
I posted my MRI results yesterday. Here are my symptoms:
- It started two-ish weeks ago with sharpish but quick (zappy) ball of foot pains on toe-off (2/10 pain - initially only pain on toe off and no pain underfoot) one day after a weird feeling in my foot during an activity. Upon first zap, I went into offload mode (this ain't my first rodeo with big toe crap)
- After 4 days, the pinching resolved, no pain on toe off in Birks, but it started to become more of a squishy bruise feeling slightly above (above = toward the toes) the lateral sesamoid. When I feel it underfoot (not always), it feels closer to the second toe than it is, and it doesn't seem worse on toe off - it's just kind of there, hanging out on the far lateral side. Maybe 1-2/10 pain on walking when I feel it, 2-3/10 pain if I press into it with my thumb. I can also make it go away by touching it. It doesn't make me need to stop walking or make me limp.
I met with an orthopedic surgeon (as a second opinion from a doc who ordered the MRI last week) to go over the MRI today. The results sounded really bad on the radiologist's report, but the orthopedic surgeon said the radiologist added a bit more dramatic interpretation than he would. The doctor visit:
- Yes, I have a bit of bone marrow edema in both my sesamoids on the right foot, but only one is symptomatic, and it's the one that's not as bad on the MRI. He thinks my pain is actually from the cartilage issue at lateral sesamoid, not the bone itself. He said we treat what's symptomatic, not everything the MRI says. (He is also of the belief that BME does not equate to stress fracture, automatically.)
- He pulled my toe back really far and pushed all around and under my sesamoids and could not recreate any pain. Like not even a bit of pressure, which was actually embarrassing because I have definitely had some transient pain! just not directly over the sesamoid bones... but he even pressed hard into where I have transient pain, and nada.
- He had me walk across the floor barefoot - no pain. He had me go up onto my toes on only one foot - no pain.
- I left his office with somehow zero pain, despite having a slightly squishy bruise feeling under my foot before the appointment. My foot has not felt worse since the appointment than it did before, despite all that pokey-doking, the barefoot walking, and the one-legged heel raise.
- His recommendation - keep wearing the cork Birkenstocks I'm wearing or go back to the carbon fiber plate I used in my shoes one year ago (for turf toe) and aim for 6 weeks of not aggravating it, and go from there. He said the minor aggravation I feel now is OK, and he expects it would improve if I continue as I have been and take it really easy.
- He said I could start sesamoiditis-specific PT whenever because my symptoms are very mild, the sesamoids themselves aren't painful to the touch, and I could do a heel raise and walk barefoot and have no standing pain. He said I am where many are when they come out of a boot.
- I got a little teary eyed and asked him what we will do if it's worse or keeping me from living a full life in 2 years, and he said, "we will cut it out." I said, "the one that hurts, or the worse one on the MRI?" He said, "the one that hurts." I said he seems confident that surgery would be an option for me even though I'm scared it's not because the MRI doesn't match the pain and he said, "I am confident. Your lateral sesamoid is being aggravated by the cartilage issues, and I would cut it out if it can't heal."
I'm feeling a bit stuck because I intentionally chose a doctor who has real experience with sesamoiditis/sesamoids -- he was mentioned multiple times on a local forum when people asked about sesamoids and he regularly performs sesamoidectomies. I asked how often he treats sesamoiditis, and he said regularly, and with pro athletes (this is true -- he works with local DC teams and ballet).
However, he also didn't suggest any of the super conservative things this sub seems quite confident about, so I find myself in this awkward space of "do I listen to the doctor, or do I take things into my own hands and put myself in a boot for 6 weeks or go NWB? Bone marrow edema seems very bad!"
It may seem like a "why not, just to be safe," thing, but I've been so anxious for the past 2.5 weeks that I already have compensation pain in the other foot (I'd actually say the other foot is more symptomatic right now, especially at the top of the big toe and along the side) and my entire body already hurts from being so... stiff. So going into a boot or using crutches feels risky to me, too, in other ways.
(P.S. - why can't I pull a Jordan Peterson and get put into a medically induced coma for 8 weeks while someone comes and manually exercises all parts of my body for me?)
Anyway, this is a really long post about not wanting to have any regrets, be it throwing everything and the kitchen sink at this and going insane in the meantime, or causing a new issue in my other foot, or missing an opportunity to really get ahead of this.
I'm thinking these are my options. Keep in mind that I can stay home 95% of the time, if I want, because it's summer and I'm a teacher:
a. Continue to take it easy at home in the Birkenstocks for 3-4 weeks. If all stays calm, start PT. But keep steps pretty low and progress to more walking in Hokas or Altras after the 4 weeks.
b. Continue to take it easy at home in Birkenstocks and Hoka Bondi (I've already found my Altra, without a dancer pad, is too flexible to feel safe right now, despite much preferring its toe box width), for 3-4 weeks before starting PT.
c. Try my Hokas with carbon fiber plates again, reliving summer 2025. So awkward. So stiff. Back to walking like Frankenstein. (Hokas are a little narrow for my toe box)
d. Cut holes in my plastic Birkenstocks to offload the sesamoids and mostly use those. Start PT in 3-4 weeks if it goes well.
e. Go NWB or booted for 6-8 weeks and pray the other foot and my knees don't get any worse than they already are with just stiff, careful walking. Start PT after transitioning back into a shoe?
**Note 1: For all options, I'd do a little heel biking (if in Hokas, maybe with plates) and chair cardio and upper body weights for exercise. After the end of the period I discuss, I would not return to regular exercise etc! I'd add a few minutes a day of protected walking for a while, continue PT, etc like I did with my plantar plate tear, but even slower.
Note 2: you do not see Hoka/Altra + dancer pad on this list. I have, much to my anxiety, tried and failed the dancer pad experiment. While I can walk in them, and they do seem to do something, it seems they also to press into the lateral sesamoid/lateral edge region after a while (or press some edema into that area - when I remove them, there's squishiness built up at the edge of them where they're offloading), but putting it any further off to the side doesn't seem to be offloading anymore. The bruisy squishy feeling only increased after a couple days I tried the dancer pad. Maybe I don't have it out far enough, but it just generally bothers my foot while maybe reducing the bruisy walking feeling briefly. I would love for that to be the solution, but alas! I need dancer pad-free or improved options.
This is officially the longest post I've made on Reddit. Thank you for reading it! I hope to figure something out that makes me feel confident enough to commit to it, stop frantically reading the entire internet, and move forward with some semblance of a plan.