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The response to the question below was authored by Marc Mitnick DPM
sesmoid
by Dana
(West Chazy, NY)
I was seen by a podiatrist who upon x-rays told me that the sesmoid bone in both my feet was in two pieces. He gave me a cortisone shot. Less than a year later, both feet ache, but in particular the left foot is in great pain. My podiatrist moved out of state and I had to be seen by a different doctor. After 5 months of waiting for an appointment, he came to the same conclusion....I have extremely flat feet, sesmoid bone in both feet in 2 pieces. He told me he felt I was born that way, instead of an injury. I had been losing weight and was doing 2 miles a day walking outside or on a running track, but now I've stopped walking and gained 35 pounds. This doctor said he does not like cortisone shots. He did a prescription orthotic. After several weeks of trying this orthotic, I stopped using it. It was too painful to wear it. The doctor ordered a bone scan but felt "the xray's were fine, the bone scan would tell if the bone is fractured." I thought 2 pieces meant fractured, but didn't question that comment. He said if there was a fracture we would do surgery and remove the bone. The technologist who did the bone scan asked me how I did this, by overuse or injury? Not sure what he saw, but he said the left was definately worse than the right. The doctor called and said I either had a bone fracture or bone bruise. He ordered a MRI. The result of the MRI apparently showed no fracture, but that
Hi Dana,
I can appreciate your problem. Two sesamoids to me means a bipartate sesamoid which is actually two bones instead of one, which occurs fairly frequently. The can be confused with a fractured sesamoid and may be hard to tell the difference at least on x-ray. If the MRI showed no fracture then go with the diagnosis of sesamoiditis or inflammation of the sesamoid bone.
The problem as I see it is that the doctor is not being aggressive enough. If you are overweight, and your sesamoid bone is very prominent due to a flat foot, it can be very difficult to clear up because you are constantly re-injurying it when walking and certainly when exercising.
I do not know what kind of orthotic you have but they do play an important role in recovery. A cortisone injection would certainly be indicated as well as physical therapy. You must avoid the treadmill, but you certainly can try an exerise bike because unless you lose weight, your weight issue will also be a factor in aggravating the sesamoid bone.
If the orthotic is uncomfortable tell the doctor what is bothering you about the orthotic and have him make an adjustment to it.
Marc Mitnick DPM
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ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
