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Sesamoid problems?
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By JSH
Administrator
Aug 13, 2010
JSH @ home <br /> <br />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?


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By Mike Pharris
From Longmont, CO
Aug 13, 2010
Belay at top of P3, "Three Tiers" Ten Mile Canyon. 11/30/12

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.


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By slim
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.


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By Jasmine Kall
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!


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By Stich
From Colorado Springs, Colorado
Aug 13, 2010
Coffee after freezing our asses off near James Peak.

I hurt mine from kicking what I thought was an empty cardboard box. Duh-oh! It took nearly six months to heal.


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By JSH
Administrator
Aug 16, 2010
JSH @ home <br /> <br />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.


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By JSH
Administrator
Mar 3, 2011
JSH @ home <br /> <br />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 big toe joint, is not a happy camper.  He must die.
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.


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By Highlander
From Ouray, CO
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..


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By JSH
Administrator
Apr 25, 2011
JSH @ home <br /> <br />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.


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By JSH
Administrator
Apr 29, 2011
JSH @ home <br /> <br />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.


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By Brent Apgar
From Out of the Loop
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


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By Timothy Mark
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.


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By darryl banks
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


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