Sesamoiditis - I think

by LB
(USA Pacific)

Hello, Dr.,

I am 48 yo female, former dancer (ballet and tap) who, except for a bout of achilles tendonitis a few years ago, have never had foot problems. I don't wear high heels (rare occasions). A 3 months ago, while on a granite tile floor (barefoot) I felt a sharp, very very sharp pain under the ball of my big right toe. I wasn't doing anything fancy, simply turning around. the pain shocked me, but didn't continue. A day or two later I felt it again. I have worn birkenstock commercial orthotics just for comfort, and they seemed to help in my everyday life. I went away for about 6 weeks shortly after, and wasn't very mobile, so the pain seemed to subside. After returning, I continued my activities, fairly normally, always waiting for the pain to come back, and back it did come when I chose to wear some flat tennies with no support. Now, every day or so the pain hits me on the outer, under-side of that big toe.

No Xrays yet, but it's been about 3 months. I saw a podiatrist and he fitted me with a Jpad until my orthotics are ready. I thought it worked great, but have noticed the prelude to pain now, even with the pad. Given the info, do you concur with diagnosis? Would you get the Xrays?

I am wondering what kinds of shoes to purchase, as well. I am trying to baby my foot with the idea that just in case it is a fracture I should

probably do the rocker toe thing as well.

Thank you very much - LB

Hi LB,

Sesamoiditis certainly would be my first guess; it is pretty easy for a podiatrist to diagnose so since your podiatrist gave you that diagnosis, go with it.
There is always the possibility that the bone is fractured and the only way to tell would be with an x-ray, BUT, sometimes a fracture so small will not show up on x-ray and if the pain does not subside with your new orthotics and other treatment, you may require an MRI.
The fact that the foot felt better with the J pad is encouraging; the fact that the pain is starting to come back may be due to the fact that the pad itself is flattening out and is not as supportive as it was initially.
I find in most cases particularly those individuals who are quite active that the orthotic alone will not be enough; you may require anti-inflammatory medication, short term, or even a cortisone injection. The problem being, every time you walk on the foot, you re-injure an already injured area. So, do not be surprised if it takes some time to finally go away completely.
Good luck.
Marc Mitnick DPM