Sesamoid issues: Anyone else dealt with this?

I tried to restart an old thread last week, but nobody jumped in.   Long story short, I have shattered the medial sesamoid in both of my feet.  It's been an ongoing problem that was made worse by a fall this spring.  Climbing shoes are a hard no until I get something figured out to reduce the inflammation and start the healing process.  I'm working on some carbon foot beds (to prevent my big toe from bending) and custom insoles (to align everything else).  That should make my ice boots and approach shoes work for now, and keep down inflammation.  I stopped climbing for about 2 months and it didn't make any difference, so I'm trying to stay active where I can.  Has anyone else dealt with this?  Avoiding surgery seems to be the way to go, but any information by folks who also climb would be great.  Thanks in advance!

I have sesamoiditis in one foot, also medial, however, it is not fractured. It has been inflamed and painful for 10 months. The only thing that has really helped is rest and a softer everyday shoe. The ortho gave me dancer's foot pads which I don't tolerate well, but I would hope if you paid for custom orthotics for the problem they would be better than dancer's pads. I also have hallux rigidus in the other foot. I take curcumin with piperine, quercetin and boswelia and have tested efficacy by going on and off of this cocktail. It really does help reduce inflammation for me. I don't recommend them unless you put in your own due diligence researching to see if they are appropriate for you. These OTC supplements can be can be risky for some people. They can have side effects, e.g.curcumin can thin blood/promote bleeding, and they can have drug interactions etc.

I took several months off climbing to try to let these heal, but they are still problematic climbing. The Hallux rigidis is not something that will heal itself. I have been adjusting footwork and been more selective with what I climb. Slab is the absolute worst, along with anything requiring pointing the toe on a hold. I try to edge as much as possible right at the ball of the foot, and to use outside edges a lot more often as that part of each foot is it is now the strongest. Some crack climbing is also OK. I also re outfitted my shoes. I had a pair of TC pros resoled with added midsole for stiffness, and found Scarpa Boostics to put the MTP joint in less stressed position, along with having more stiffness and support.

I have had sesamoid issues, including surgery.  Still dealing with pain 4 years later. This is likely going to be an ongoing issue for you.  Stretching and strengthening through PT are about the only things that seem to help mitigate my pain.  Wish I had better news....good luck. Getting the right shoe will help. I am wearing the Evolv Supra, extra stiff and with the rand support to help keep shape. Seems to help tremendously relative to some softer shoes I have.

I also have a fractured medial sesamoid on my right foot, with osteonecrosis.  It was quite painful for a while, I tried taking a bunch of time off, didn't help that much.  Also had ortho make me a insert with morton's extension to prevent dorisflexion of the toe- definitely helps when using it.  About a year out from original diagnosis... still hurts, but doesn't really limit me.  Considered surgery, don't think it is worth the risk.  Lots of people still have pain, lots of people have issues with thick scar formation on sole of foot causing issues and removal of medial sesamoid puts you at risk of bunion formation due to changes in biomechanics which opens up a whole new can of worms.  I have just come to accept that it will always hurt a bit.  I am able to run without too much issues (aches afterwards), climbing is certainly the most aggravating- I just accept it, not gonna quit climbing and doesn't hurt enough to have ortho cut it out.  I switch to Altra shoes for running which made a BIG difference, MUCH more comfortable.  

Paul-B wrote: I also have a fractured medial sesamoid on my right foot, with osteonecrosis....Considered surgery, don't think it is worth the risk.  Lots of people still have pain, lots of people have issues with thick scar formation on sole of foot causing issues and removal of medial sesamoid puts you at risk of bunion formation I have just come to accept that it will always hurt a bit.  I am able to run without too much issues (aches afterwards), climbing is certainly the most aggravating- I just accept it, not gonna quit climbing and doesn't hurt enough to have ortho cut it out.  I switch to Altra shoes for running which made a BIG difference, MUCH more comfortable.  

Agreed. My surgery included a weakening of some connective tissue on the top of your foot to prevent it from pulling your big toe in, thus avoiding a bunion.  Surgery was 3 months to run and 1 year to "full recovery".  I second Altra shoes for running/trails.

Paul-B wrote:  I switch to Altra shoes for running which made a BIG difference, MUCH more comfortable.  

Ditto!

Thanks for the feedback!  I've already embraced the long-term issues, and hell, I can still do about anything, it just hurts.  In my discussion with the Orthopedic surgeon, she mentioned a lot of the things you guys did, so it's great to hear it really helps.  She was also fairly against the surgery unless it's a last option, so I was happy to hear that too.  Thanks for the supplement idea/advice.  Avoiding prescription drugs is my preference, so finding other options is key  I'll look into the ones you mentioned.  I'd never considered adding a midsole to stiffen a climbing shoe, so that's a great starting point when I get back to those.  Paul, how do your orthotics and morton's toe extensions fit in your shoes?  Is there too much heel lift in some shoes?  This has been a big concern for me, as I can already have fit issues with my heels.  Do you put those in you running shoes?  I ordered the morton's extensions directly, and I'm considering having a local boot fitter integrate the morton's extension and build me an insole with a little more athletic design rather than go to actual an orthotic.  The orthotics folks just seem to be geared toward type 2 diabetics and mall-walkers.  Oh, and Paul, give Hoka's a shot if you haven't.  I've been wearing the ATR's for about a year, coming off of Altra Lone Peak's, and the stiffer sole made a big difference.  Still wear the Altra Timp though.  

I have AVN in one my sesamoids--got the diagnosis about a year ago. I have to wear stiff climbing shoes (Miura VS) and use the Altra's with custom orthotics.  I had a lot of trouble with the fit in my heels at first because of the orthotics.  I taped my heels for about a month to prevent blisters and then my feet just adapted.  

I followed advice from a handful of doctors I saw:  took Calcium and Vit D supplements, used a bone stimulator, quit climbing for 4 months, did PT, dancer pads, spica taping, lots of icing and contrast baths.  But honestly, I didn't see any difference when I returned to climbing.  I had found that having stiff shoes--and unfortunately replacing my shoes frequently so they stay stiff--helps more than anything.  I also kept track of number of pitches I was climbing and the pain levels I had.  Now I have a pretty good sense of when I need to stop if I want to walk without limping the following day.

But I haven't been able to run more than 3 miles since my injury.  Can anyone in the Denver area recommend someone who makes orthotics for runners?

I've been dealing with this for 15+ years.  Got a half ass diagnosis, in that the doctor seemed more convinced that it was the cartilage in the joint being gone and the "only way to fix it is to have the joint fused", there was mention of one or more sesamoid bones (which he did not identify by name) in two pieces, but this didn't seem to be much of a concern to him, said I may have been born that way.  I have very high arches and was told that was part of my problem and sold a set of very expensive orthotics that provided little arch support and were hard as a rock so caused more pain than relief.  I have found OTC arch supports that have seemed to help.  All these years I have been "putting off" having my toes fused, thinking that the joint was the problem.  Only a little over a week ago did I find the name of the bones the podiatrist mentioned in passing over 15 years ago.  I am now convinced that Sesamoiditis would have been the proper diagnosis.

Over the years it has been Aleive, crutches, these flip flops when too painful to wear anything else   amazon.com/gp/product/B003Z…;psc=1 (which it looks like I can't get anymore :( ), doing nothing but laying around with my feet elevated on the weekends till the inflammation went down.  All the while dreading the day they wouldn't heal on their own and I would have to have the joints fused.

Just started climbing about this time last year.  I was worried I would not be able to climb due to the problems with my feet.  Always thought that bending my big toe upward is what set off a flair up, and it does, but that's not the whole story.  I have been pleasantly suprized.  I have only had two flair ups this year the first was knocked out within a few days with icing and Aleive.  As I type I am two weeks into my second one.  The last ice climb I did this season it was a long hard walk in and out.  There had been one skier in and out and one person on foot, over waist deep powder.  Hard uneven walking with a pack set off another flair up that I am currently dealing with.  Thought I would be golden with the rigid soles of my ice climbing boots so my toes weren't bending.  The rocking of my feet  side to side walking on the soft uneven surface did me in.  I think I would have been better off post holing the entire way.

Now having a better idea of what I am dealing with...I ordered one of these   amazon.com/gp/product/B009G…;psc=1 which has made it much easier to continue working.  I am a self employed mechanic, on my feet all day, weeks of work booked so I have to keep going somehow.  Crutches and flip flops not ideal.

My next step is to work on some custom insoles with a lot of arch support and a cut out under the big toe joint to take pressure off the sesamoids.  And a set of approach skis for next ice climbing season.

I have used ridged insoles to prevent my big toe from bending but the lack of padding under the sesamoids was problematic.  Now I think more problematic than the small amount of toe flex when walking.

Chad, I see your location is Bozeman.  I live in Logan and work in Bozeman.  Climb at Spire twice a week. (If my feet aren't F'ed up).  If you come up with insoles that work well I would like to hear about/see what you come up with.