foot trauma resulting in sesamoiditis

left foot trauma 8 weeks ago after using wobble board for first time, used it for 15 mins x5 days..went to docs in agony, sent me x-ray and says nothing broken. went to biomechanics and they say sesamoiditis and torn ligaments. say rest for 4 weeks ans ice x 4 daily.. also on ball of foot area is extremely reddish purplish in colour when not elevated. very confused as should i be getting heat to help heal or am i damaging healing by icing.. in an awful lot of pain, am so active and do a lot of walking and worried so much i wont be able to get my health back.. also i am 46 and on riveroxoban anticoagulant for life due to 2 pulmonary embolism and another clot found last nov 2014.. hope this helps kind regards judith

RESPONSE

Hi Judith,

Sesamoiditis is a condition that can be very troubling and difficult to remedy.

Since it has now been eight weeks since your accident and you are still in a lot of pain, that would be cause for concern if you were my patient. The first thing I would consider would either be another x-ray or even better a bone scan, to see if the sesamoid bone is fractured.

Unfortunately in many instances a small fracture of the sesamoid bone may not show up initially on x-ray. So if there is a long period of pain, as in your case, you have to rule out a fracture. A bone scan would probably be better than a second x-ray when it comes to the sesamoid bones.

Foot structure can also have an adverse affect in allowing a sesamoid to heal, particularly if there is no fracture.

If you have a very high arched foot, that puts more pressure on the sesamoid bones as you can see by the diagram (blue arrow).

The other problem is if you do not have much fat on the ball of your foot. Many people have bony feet, meaning there is not fat to cushion the ball of the foot, so without this fat, the sesamoids are hitting the ground or sole of your shoe and are not protected, thus aggravating the situation.

As we age, most of tend to lose fat on the bottom of the foot, so this only adds to the problem.

As far as your question regarding ice vs. heat, I only recommend ice for the first 24 hours after an injury and that is because ice will reduce inflammation and therefore reduce pain. The problem with ice is that is does not promote healing as it reduces the amount of blood that comes into the area and it is blood that brings nutrients to heal an injured area.

Heat on the other hand, increases circulation to an injured area and improves the healing environment.

Heat alone will not heal this problem. I realize because you are on blood thinners you cannot take anti-inflammatory medication, which normally would be prescribed.

Having said that, there are other things that can be done.

First, after checking to see if the bone is fractured and assuming it is not, you might consider asking the doctor for a cortisone injection into the area.

Secondly, you should also consider an orthotic for your foot, built in such a way that it takes the pressure off of the sesamoid bone so that you can bear weight and walk, but also reduce the stress on the sesamoid bone so that it can heal.

If an orthotic is not an option, then you could also consider going into a cam walker which is a walking cast that might allow you to ambulate without putting added pressure on the sesamoid.

Lastly, you could also consider going non-weightbearing with the use of crutches to keep all weight off the sesamoid bone in an effort to allow it to heal at a quicker rate.

As stated earlier, you first need to make sure it is not fractured.

Marc Mitnick DPM
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