Sesamoiditis w/fracture

by JC
(California)

Hello Dr. Marc,

I have seen a podiatrist and have had x rays which revealed a fracture in one of my sesamoid bones. The podiatrist felt the fracture was an injury from childhood that never fused. I am 49 now and I've had this recent injury for about 3 months brought on by overuse (running and golf) and it is only the last 2 weeks that I have committed to being non-weight bearing. It seems to have helped a bit with the swelling in the toe but not so much with the inflammation in the sesamoid area. Prior to fabricating this non-weight bearing shoe that allows my joint/toe to float I had walked on the outside of my foot and been hobbling around with great discomfort. For the inflammation, I've tried, Chinese herbs, advil, homeopathy, bromelian, Zymafled, and finally a shot of cortisone that caused major swelling and redness in the joint all the way to the tip of my big toe which lasted a week! So now 2 weeks into floating my toe and icing twice a day I am wondering how long until I might notice a difference in the swelling at the joint and how long until I may still experience the pain. I am also wondering if I should try advil or aleve in larger doses for several weeks instead the dose and time frame prescribed on the container. Also, should I still be icing? I have not worked out for months and would love to be able to walk again with out protecting my toe with every step. Do you have any suggestions as I would love some support? Thank you!!
ps My podiatrist devised orthotics which only made matters worse as the heel on them caused me to put more pressure on the ball of my foot and the rigid arch hit right under the sesamoids causing great pain and more inflammation so I have never been able to wear them.

Hi JC,
Well, hopefully the problems with the orthotics can be adjusted as I think that would be the first treatment you would want to try.
If, you actually have a fractured sesamoid (have you had a bone scan or an MRI?)and the orthotics do not help, you may have a problem.
You do not mention which sesamoid it is, but if it is the one closer to the second toe, then you might want to consider having it removed. If it is the other sesamoid, then removing it becomes a problem.
That is why I would recommend you work with your podiatrist in an effort to try and find an orthotic that takes pressure off the sesamoid, because beyond that there is not all that much you can do.

Marc Mitnick DPM