Sesamoid fracture question

Can I get a warm/fuzzy here? Can someone lend some experience here? I’m basically looking for “Good chance this will heal fine - put in the effort” ; “This is a half court buzzer beater, but it’ll only get worse”; “5% chance, usually doesn’t get worse unless it starts getting inflamed, then you need to remove that bit; up to you”

I’d had a bruise-level of discomfort in my foot for months (probably 9mo now). I tried adjusting my shoes/fit/insoles/etc. Went to doc, Sesamoid is fractured. Doc gave me impression as I was reading through the lines that this probably wouldn’t heal and might break again easily if it does; give up running/cycling. (M; 43; desk job) X-ray film pic shows a clear gap between the bones (after 9mo+ of mobilized use).

Despite the low probability of success, it seemed like she wants to immobilize it for 2mo and use electric stimulation to get to heal. It felt like she was putting her blinders on and doing what she could rather than thinking if it was worth it - my read anyway. I’m thinking if the pain isn’t all that painful, it’s not going to heal, does it make sense to even bother? (To which I didn’t get a good answer. )

I’ll probably get a 2nd opinion after I ask around unless there are some slam dunk positive experiences.

Stupid question - Can I use my cycling shoe instead of the boot? Seems like that should immobilize it in a natural position all the same. The boot does have a arched sole, spreading out the load a bit. It also has a different ride-height than my shoe, so I’d need to a lift to prevent back injuries.

…get another opinion from an Orthopod, and +/- MRI to see the exact location of the sesamoid. Some are really invested in the surrounding tissue (tendons etc), which makes resection more difficult, and/or non-op healing more difficult.

Really sorry to hear your troubles. I had a sesamoid problem although not fractured so can understand the discomfort you must be going through. Sending warm thoughts for a full recovery.

My podiatrist did mention potentially removing my sesamoids should they continue to be a problem so at least that is an option. I’d much rather have surgery to keep the bone, however.

Does your podiatrist run? I can’t recommend a sporty doctor enough. They will know treat your problem with the proper amount of concern for your athletic livelihood.

Well first I’m sorry your foot hurts. Pain in that area is a problem for sure.

Did you have a specific memorable injury of moderate or greater severity. If not that sure looks like a bipartite lateral sesamoid to me. The lateral one is more likely to be bi or multipartite. Fractures require a significant amount of trauma and I have never seen a stress fracture of the lateral sesamoid (I do not have many runners in my practice however)

You might have either pain at the bipartite junction or sesamoiditis/sesamoid articulation arthritis. An alternative but less common diagnosis is adductor tendinitis but that is far more common in dancers and presents differently.

Unfortunately all of these are hard to treat. Yes. You can try enforced rest in a cast or air cast. If that doesn’t work sometimes shockwave ultrasound will work for bipartite sesamoid junction pain I often will inject w corticosteroid but ironically an injection of the MTP joint will have a positive effect potentially for all of these

Sesamoid excision is a last resort and both should be removed to avoid deviation of the toe afterwards Recovery from this is 3- 6 months.

Am MRI may help now but very specific questions have to be asked. A bone scan may also be helpful and most are combined with a Spect CT scan which has made the bone scan a lot more specific

Best of luck

Couple thoughts…

It’s worth while getting an X-ray of the other foot. Not uncommon if it’s bipartite to have it on both sides. If you’re still having pain at this point, get a mri. You’re looking for marrow edema to indicate fracture or trauma and hopefully not avascular necrosis

Excision should be a last ditch effort. Removing your fibular sesamoid has a pretty well documented risk of hallux varus deformity… essentially opposite of a bunion. Best analogy of a sesamoid bone is a piece of gum in long hair… you can’t just remove it, you have to cut a lot of tendon to get it out. Also, best surgical approach for a fibular sesamoid is a plantar approach. I avoid plantar foot incisions like the plague. If you get a hypertrophic scar, that can be just as painful as the sesamoid

Some treatment options… pad around it to spread the force around it instead of on it. Bone stims can work if it’s actually a fracture but not entirely convinced from just one X-ray that it’s a fracture vs bipartite
Orthotics with a first met head cutout, especially for cycling shoes since they’re really hard

Good luck! For as small of a bone as sesamoid are, injuries can really be debilitating

1 Like

I agree with the above, get an X-ray of both feet as my sesamoid has the split in both feet. The doctor still thought it was a seamoid fracture and treated it as such even thought I had no injury event. The pain went away after a month or so and I assumed the diagnosis was correct. Then a year later the exact same pain showed up in my other foot and again with no injury event. My issue turned out to be gout. I changed my diet, lost weight, started cycling and eventually ended up here.

1 Like

Thanks for the responses. That bipartite consideration might make some sense as there’s no swelling and no obvious trauma event.
Short term: I’m having the ortho office send the X-rays , which have at least one right foot. Might not be the right view though

Long term: I’m going to try to find someone who deals with runners. I don’t run currently, but I feel they’d be able to tackle my outcome questions better

Shimano xc9 (completely rigid sole) as a walking boot alternate to immobilize the sesamoid? Seems like itd do the same thing as the boot more casually around the house.

Ortho wanted an arched mid foot, but rigid is rigid. The shoe also limits foot movements more as there is no interior padding. It doe not limit ankle movements, so it’s probably still see “daisy chain” stress.

The toe is slightly contoured up vs floor flat. I’m using a firm aftermarket insole I’ve found to fit me perfectly, so only lug cushioning. I might try a memory foam insole to limit specific stress points.

I broke my sesamoid back when I was a teenager and an avid runner. It hurt like hell at the time, but it healed well with rest. The two segments never fused back together, but it’s rarely a problem. I have run a 50K, five marathons, and many more races of shorter distances without issue. For running, I often find it useful to cut a little hole in the insole under the ball of that foot; that’s a trick I learned with custom orthotics.

Dr office sending x-rays…. On a f***ing CD. A CD? It’s not 2018 when you could find a DVD/CD drive on a computer at work or something.

“Can’t you just email them?” “Theyre on a CD”
Maybe they don’t have a DVD drive either.

Think of the bone like your knee cap. if you break your knee cap just immobilizing the knee won’t really help it recover, need to take stress off the link between your quads and your lower leg. Using a bike shoe allows weight on your toes so still puts pressure on the sesamoid by putting pressure on the tendon. A boot tends to make it hard to put weight on your toes. If you’re careful you can get the same effect though, just make sure you remember it’s not the immobilization you’re really after.

Plus you need to keep from putting weight on the sesamoid (pressing down part, not loading the tendon) which is where the padding of the boot is useful or insoles with cutouts

Legally the only way to email is through an encrypted email which is hard between two unrelated businesses so a physical object in the mail is the easiest way to do it. Plus dicom files can be large

That looks normal to me. They are supposed to be in 2 parts.
My daughter had “sore-foot problems” for a long time which eventually stopped her running. We went to THE super-specialist running foot guy and got an MRI and x-rays and it looked just like yours. The split is normal - It wasn’t considered to only be in 2 bits because it was broken. The problem with our daughter was that the gap between them was slightly larger (by a fraction of a millimeter) than it should have been and the tendon that it all sits in was inflamed.
The solution was i think 3 or 4 months in a foot brace (£40 from Amazon) and then gentle return to running. She’s back on the track now and never had a problem since. Softer shoes for the bulk of road work helps. Think Hoka.

Don’t be scared of taking time off to heal - I’ve just had 6 months off the bike for an injury and i’m back to 95% full power already. And avoid surgery - cutting bits out of you can create as many new problems as it solves… Try the “wear a £40 padded boot” approach before you try the “let’s cut holes in the bottom of your foot” approach.

Got the xray files today.

The right foot (not injured) similar bone is not split. The left is.

No plan to cut up foot as the pain is minimal now.

i have a broken sesamoid! and yes, from what I gathered from multiple doctors, it is too small to fix, and those that are conservative are HIGHLY against getting it removed. The solution: i had off-the-rack insoles that were heated up (literally by a hair dryer) and the foot guy pushed his thumb into it to create some extra room for the ball of my foot. I have been riding strong for 9 years like this!!

I would 100% recommend getting to an insole place and having them take a look. Prob don’t even need custom insoles, and can get this result for less than $100.

good luck!

not always; i believe that’s a bicuspid sesamoid when it’s in two.