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Wednesday, March 31, 2010

I crushed my sesamoid

Way back in November, I hurt my foot working out (on the Wii). I was doing jump lunges and jump squats barefoot. The next day, my big toe hurt really bad. I didnt really think anything of it at the time. I just thought maybe it was a pulled muscle or bruise or something and it would heal. The pain subsided after about a week, but then came back a few days later after another intense workout. After a few weeks of the pain coming and going, I finally went to our local family clinic where the doctor told me he really didnt know what the problem was. He said that feet are complicated and it could be any number of things, but to just lay off it for awhile (it's kinda hard to layoff a foot) and if it doesnt get better to come back. Over the holidays, it didnt bother me quite as much because I wasnt working out and was pretty much "laying off it". After Christmas break though, I started to workout again and the pain came back, but this time it was just a constant ache (of varying degrees of pain) in most of my foot rather than a sharp pain in my toe. I finally decided enough was enough and went to see a podiatrist while we were in Anchorage over spring break. They took several X-rays and the doctor told me that I had broken my foot. The actual diagnosis was a crushed sesamoid and sesamoiditis. Your sesamoids are located under the ball of your foot and help to control the motion of the big toe. Their are two of them and they are round, floating bones (similar to the kneecap) about the size of a pea. In the top X-ray you can see them just under the second knuckle of my big toe. In the bottom X-ray you can see them distinctly under the ball of my foot (the position they made me get in for this X-ray was extremely painful). For some reason, the picture I took of this X-ray wont rotate. In both x-rays you can see (click on the pics to make them bigger) that the sesamoid toward the inside (medial) of my foot still retains its nice round appearance, while the one toward the outside (lateral) of my foot appears to be more of a crushed, screwed up, half circle. That's because the top half of the sesamoid bone is in small, shattered pieces. The doctor said that she thinks it has already started to heal, but that it will most likely take at least another six months to heal to the point where I dont feel pain anymore. She told me that the pain has spread over my entire foot now because the tendon (or was it ligament?) that goes in between the two bones has become inflamed and arthritic (sesamoiditis).

The doctor gave me an over the counter orthotic to put in my shoe which provides more arch support, thereby decreasing the amount of pressure that is put on the sesamoid. I have also been instructed to "lay off" it some more. I am not allowed to wear heels :( I am not allowed to do anything that makes my foot come down hard on the floor like jogging or jumping. :( I am not allowed to do anything that causes my toes to be bent forward very far like some yoga poses. :( I was instructed that a biking would probably be the best form of cardio for my current broken foot situation. Considering that its still negative ridiculous degrees outside, I found a good deal ($40) on a stationary bike and picked it up a few days ago. Today I rode 12 miles in 45 minutes and burned 500 calories. Not bad. I am feeling my motivation creep back in.
Doctor says if the pain doesnt get better in a month that we will have to move on to a boot. Then if that doesnt work, steriod injections. And if that doesnt work, surgery. My foot is feeling better already, although not as much as I had hoped. I have noticed lately that I have started to roll my foot to the outside rather than putting my weight flat down. I am trying to be conscious of that and trying to stop doing it. I feel like a bum wearing flats everyday to work, but it's definitely better than pain. At this point, I just hope that it heals and that this will not be something I have to live with for the rest of my life.


Jamie said...

Hello, I wanted to let you know I have the same problem you do. My doctor put me in a boot immediately. It doesn't hurt while wearing the boot, but as soon as I take it off, I start walking on the outside of my foot because I have not forgotten the pain when putting my weight on the sore spot under my toe. I am very depressed because I am very active and am waiting to see my podiatrist in two more weeks. Do you think there is a chance the crushed sesamoid bone can heal? I am praying for miracle. Please let me know how your healing process is going. Also, are you going to a podiatrist or an ortho foot surgeon?

alisha said...

Hi Jamie...

Let me give you a bit of a timeline of the injury and healing of my foot.

Oct. 2009-broke the sesamoid

Oct-Mar- on and off pain always increasing with exercise or heals

Mar 2010-went to see a podiatrist and got official diagnosis of a crushed sesamoid

Mar-Sept 2010-was careful with my foot, stayed off of it as much as possible, no activities involving bending the toe or putting weight on the foot, wore flat shoes with good arch support including an insole

Sept 2010- started physical therapy because pain was moving up my leg and into my hip. the general idea from the p.t. was that I was carrying my weigh on the outer edge of my foot, which was changing the way I carried my weigh on the entire right side of my body.

Sept-Dec 2010- started working with the p.t. on exercises to strengthen all of the muscles that had atrophied from disuse, including exercised for my hips, glutes, calves, arch, and toe.

Oct 2010- Went back to podiatrist to get update on the healing of the bone and to review with her my p.t. care plan. the x-rays showed healing and she was please with the progress.

Jan 2011- Started working in some more normal workouts and phasing out the p.t. exercises. listening to my body/foot when it tells my i'm pushing too hard, I back off. I used ice packs after a long day on my feet or any major activities with really helped alot.

Mar 2011- Went back to the podiatrist for a final visit. The bone itself is pretty much healed. She was pleased with the way the shattered pieces of bone had come back together. The final x-ray showed the bone back together as one solid mass agian. She says that i will likely always have some arthritis and that I should continue to be careful with arch support and the types of shoes that I wear. She gave me the all clear to wear heals and go back to all normal activities with the advice to just listen to my body and ice it when needed. She said that it was unlikely that I would reinjure it as long as I continue taking good care of it.

Present- I still have some pain/soreness/ stiffness when I do certain activities, but it is mostly caused by the weak muscles around the toe, not by the bone itself. I am back to normal levels of activity, including jogging, lunges, yoga, and my dance classes that I missed so much.

I really think it was having a good physical therapist that helped my so much, but I also think that I had already given the bone a good 9 months to heal before I started going to the p.t. Physical therapy wont work if the bone is still broken. Give yourself some time to heal, invest in a stationary bike to get your cardio in, then find a good physical therapist after you've given the bone some time to heal.

Good luck!