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Aug 13, 2010
JSH @ home  photo courtesy of Gabe Ostriker
Hey all, got any stories to share about (of course!) how long it took to get better?

I just got back to climbing after a ~4 week break for a virus, then immediately started hurting in my foot. It grew over 3 weekends to the point where it shut me down last Saturday for good. Hurts just behind the big toe/ball of the foot, towards the heel.

Went to the podiatrist today, and he says it's my lateral (fibular) sesamoid; he actually thinks it's the nerve next to it. He injected a weaker anti-inflammatory (not cortisone) to calm down the nerve, gave me a scrip for oral anti-inflammatories, I'll get X-rayed soon, and have foot pads to take the pressure off the ball of the foot.

Tell me your story? You were better soon, right? right?
JSH
Joined Apr 3, 2007
1,064 points
Aug 13, 2010
Climbing above Black Lake
i'll chime in, but don't pay toooo much attention. I've NOT had this issue, but I have been dealing with plantar fascitis. the one thing that my doc has driven home to me (he is a sports medicine doc) is that i need to lay off the foot for MUCH longer than i would have thought. It starts feeling better for a week or so and i want to restart my routine, but then it hurts again. So he has told me that i need to lay off for several weeks to let it fully heal before going back to rebuild my running stamina, etc.

I'd bet the same advice would apply to you.

Not what you wanted to hear, but take a long term view, not a 'this season' view.
Mike Pharris
From Longmont, CO
Joined May 21, 2007
147 points
Administrator
Aug 13, 2010
tomato, tomotto, kill mike amato.
jsh, do a search on sesamoid, if i remember correctly there was a thread with a fair amount of info in it. my wife had one several years ago. for the most part she is doing well, but it still bothers her onec in a while. slim
Joined Dec 1, 2004
2,044 points
Aug 13, 2010
Getting ready to climb!
My friend actually broke hers and it would not heal. They finally had to take out the bone! Jasmine Kall
Joined Nov 7, 2008
50 points
Aug 13, 2010
Coffee after freezing our asses off near James Pea...
I hurt mine from kicking what I thought was an empty cardboard box. Duh-oh! It took nearly six months to heal. Stich
From Colorado Springs, Colorado
Joined Jan 1, 2001
1,495 points
Administrator
Aug 16, 2010
JSH @ home  photo courtesy of Gabe Ostriker
Thanks for the feedback, folks. I did find some older threads on rc.com, but I guess like any newly injured person I felt the need to re-ask!

Went for x-rays this morning, and it hurt to hyperextend my big toe ... not a good sign. We'll see.
JSH
Joined Apr 3, 2007
1,064 points
Administrator
Mar 3, 2011
JSH @ home  photo courtesy of Gabe Ostriker
Well, thought I'd follow up, iff'n all this might help someone else someday.

Tried lots of dancer's pads, etc., to offload the MTP joint.
I've been in a walking cast for ~4 months now.
Have custom orthotics.
Had 3 courses of steroids.
Chewed tons of naproxen, Celebrex, etc.
Been using an ultrasound bone stimulator for ~2 months.

Still not better.
Seeing ortho surgeons in April.

Here's the problem. I think some nerve runs right along the 1st metatarsal there, such that Mr. Chippie is poking it. Sure feels like it.
The MRI "lights up" and indicates inflammation right there as well.

Little Mr. Chippie, on the lower right side of the...
Little Mr. Chippie, on the lower right side of the big toe joint, is not a happy camper. He must die.


Am I stir crazy? Hells yes.
JSH
Joined Apr 3, 2007
1,064 points
Mar 3, 2011
Had the sesmoid problem many years ago before I got into climbing. I was a competitive distance runner at the time, running about 90 miles a week, it started as a dull pain and got worse and worse. Ended up taking about 3 months off from running,and off it completly, changed to different model of shoe and eventually it just went away. After this injury I stopped running competitvely and started getting into climbing. Have not had any problems since. Bottom line is it can take along time to heal, as it is real hard to stay off of it completly, and I would be willing to bet that tight climbing shoes certainly don't help. Good luck, I totally understand the suck factor.. Highlander
From Ouray, CO
Joined Apr 14, 2008
225 points
Administrator
Apr 25, 2011
JSH @ home  photo courtesy of Gabe Ostriker
Update:

Well, I have no real answers, at least yet, but - the latest with my foot is that in March, both foot docs I was seeing said "go talk to an ortho surgeon". I've seen 2 of 3 by now. Incidentally, both were somehow amazed that I actually did spend 4 months in a walking boot. And they all agree that if that didn't do it, nothing will.

Surgeon #1 gave me a cortisone shot. Cortisone isn't in general a great idea, because it breaks down fat pads, and you don't want to do that to your MPJ. But a) it confirmed that the sesamoid is indeed the problem. I mean: I walked out of the hospital with a very different gait! That was mindboggling, that gait is so very involuntary. And b) there is a chance that by knocking down the inflammation with the big gun of cortisone, it'll "stick" and convince my body not to re-inflame.

My sesamoid is in (at least) three pieces. Surgeon #1 (recommended, but at a hospital I greatly distrust) wants to go in & remove just the shards he thinks are problematic (see above; he thinks the shard at the top is worse, as it's right in the joint), but leave the bulk of the bone. Surgeon #2 (MGH, trained at Hospital for Special Surgery) says nope, whole thing lights up on MRI, whole thing's gotta go; and we have never seen hallux varus (a possible complication from removing the leverage from one side only of the two muscles that control the big toe). Both docs agree that having bone fragments isn't itself a problem; it's the body response, the inflammation, that's the problem. I see Surgeon #3 later this week.

In the meantime, the cortisone has *greatly* reduced the pain. I can put on a climbing shoe, actually climb (!!), do lunges, do yoga, and thus won't be going forward with any kind of surgery while I cross my fingers & hope it's for good.
JSH
Joined Apr 3, 2007
1,064 points
Administrator
Apr 29, 2011
JSH @ home  photo courtesy of Gabe Ostriker
Hopefully a last update, just to note the variability of approaches recommended by the surgeons:

Surgeon #1: wants to just remove the fragments, through a plantar (base of foot) incision. He thinks it's just the top fragment causing the problem, as it's directly inside the joint and likely pokes the metatarsal head with each step.

Surgeon #2: take the whole sesamoid, plantar incision.

Surgeon #3: take the whole sesamoid, dorsal (top of foot) incision. Would possibly do one more cortisone shot first. Is also Tom Brady's surgeon.

From what I've read elsewhere, dorsal incisions are highly preferable, because you avoid scar tissue on the bottom of your foot. Both #2 and #3 advised against just getting the fragments out; the entire area "lights up" on MRI, and there's no definitive way to tell exactly what is causing all that inflammation.

My plan right now is to go climbing. Then if/when the foot starts hurting, go to surgeon #3.
JSH
Joined Apr 3, 2007
1,064 points
Apr 29, 2011
Me and Spearhead
JSH-
Thanks for posting the process you've been going through. As a doc that has tried to help solve a sesamoid problem it's nice to see what other folks experiences are and what has worked for them.

The fascial release work I did helped somewhat but ultimately the person ended up having surgery and then we worked on the fascia following the surgery. Pretty similar to yours as far as the back and forth and not really finding anything to help resolve the irritation.
She found that the best thing was to climb using her approach shoe on her bum foot.
Good luck, I hope that the cortisone works for you,
BA
Brent Apgar
From Out of the Loop
Joined Oct 20, 2007
142 points
Sep 18, 2011
Hey JSH - sorry to resurrect an old thread, but I'm dealing with a similar problem. Any updates? Did you get the surgery?

My podiatrist has recommended that I try to work around the problem with orthopedics, since the next option is surgery. He says that the surgery has a high chance of complications. However, he's not a climber and I'll probably seek another opinion if things don't improve soon.
Timothy Mark
Joined Aug 13, 2010
90 points
Sep 19, 2011
i jus started to have the same problem few weeks ago. x ray showed one of da sesamoid pads missin. surgery an option but for now jus ordered orthos and eat the dull pain @ da gym n eat painkillers when traddin darryl banks
Joined Jul 13, 2010
12 points
Jun 1, 2015
Celebrating on Intersection Rock, JTree.
Bringing back a 4-year-old thread, because I'm wondering...

What happened to all you people with sesamoid injuries? What solutions did you find?



I broke R lateral sesamoid last June, stayed off it all summer, climbed in an approach shoe all fall, just started getting back in a climbing shoe.

And today, I got an xray, and my L lateral sesamoid is now fractured. And my R never fully healed.


Did anyone have the surgery? How did it go?

Does anyone know what, specifically, in climbing is causing this injury? Shoes? Type of climb?
brat
Joined Nov 28, 2007
79 points
Administrator
Jun 2, 2015
JSH @ home  photo courtesy of Gabe Ostriker
Well ... the cortisone shot worked magic for me, where nothing else had.

It was a total cure until about a month later, May 2011, when I rapped off the end of my rope, burst-fractured the L1 vertebra, and blew my left (other) calcaneus into 7 pieces. So I was immobile for a long while after that, which served as a nice rest for the sesamoid in my right foot.

The next while -- crutching, then limping, repeated x3 surgeries on the left heel -- was a bit stressful on my right foot. The sesamoid occasionally made itself known, but never as bad as other pain. I was a bit worried earlier this spring, after the last round of surgery, cast, limping, and even mentioned to my new surgeon here in PA that I might need to deal with that sesamoid, but pretty much as soon as my gait was OK again, the foot was OK. I've been climbing since spring, and climbing shoes don't hurt it.

In retrospect, I'm sure it broke during a normal climbing day, probably a stress fracture kind of thing (not trauma -- didn't fall), because I remember vividly the day it started. I'm also sure I made it worse by initially assuming it was plantar fasciitis, so I tried to stretch it, flexing my big toe, which put exactly the wrong kind of stretch on the broken sesamoid. And of course I kept climbing, just "taking it easy" (dumb!).

My understanding is that the broken bone itself is not an issue (many people have naturally bisected sesamoids). It's more about whether your body is producing an inflammatory reaction to it, and pain. Long term, either your body gets used to it (which seems to be true for me), or you get it removed, which also didn't seem to be a big deal aside from the surgery.

Best of luck! Hope yours calm down soon.
JSH
Joined Apr 3, 2007
1,064 points
Jun 3, 2015
I saw a different podiatrist, who gave me a different (correct) diagnosis: hallux limitus. That's basically arthritis in the joint where the big toe connects to the foot. I believe my sesamoids are fine.

I got better orthotics (leather, not plastic), and I can generally walk around with little pain. But climbing is right out - standing on your big toe is exactly the wrong thing for my foot.

Per the podiatrist, there are a couple of surgical options that might fix things, might not. I opted to give up climbing instead.
Timothy Mark
Joined Aug 13, 2010
90 points


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