My experience is that these buggers do linger quite a while - at least 12 weeks, esp if you are just walking a round in it (not sure of your day job). I have plenty of non athletes/runners with sesamoiditis/stress fx as well, so simply not running, while important, isn't all that it is likely going to take. How did you develop this? Trying to become a "forefoot runner"? Acute injury/jumping? Any other barriers to healing (like a significant forefoot varus deformity, hallux limitus, bipartite sesamoid)?

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

HI there,
yes this happened while I was learning the "pose" forefoot running technique (was a heal striker-how I would kill to go back ) :(
Yes, I also have a bipartite sesamoid.
Tried the cam boot but found it incredibly painful against my sesamoid-it hurt worse than anything else due to the constant push against it.
And yes, I am on my feet at work 3-4 days a week, 10 hour shifts .
I am so dang frustrated. Not sure what else I can do from here.
acupuncture? new orthotic? pt?
ahhhhhh!

I've had a fair number of these from new forefoot and minimal shoe adopters. PT not going to do much in this case. Remember, the sesamoids (and I'll assume it is your tibial or medial sesamoid) are invested in the flexor hallucis longus (FHL) tendon, and any dorsiflexion motion of the great toe puts "stress" on the sesamoid. If you couldn't tolerate a CAM boot, some type of shoe insert (call it an orthotic if you want) would be a good try. The goal here is to offload the seamoid of course. This can be done by moving pressure to other parts of the foot (esp if you have a high arch foot) or simply a soft neoprene/spenco type orthotic with a cut out beneath the sesamoid (doesn't usually work, but certainly comfortable).

Other options include non weighbearing cast immobilization (not an option for many, esp if your right foot/driving) and surgical excision of the sesamoid - you aren't there yet with only a 9 week history.

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

I appreciate your thoughts.
My insert right now has carbon ahead and behind my first toe to prevent bending and a cut out by the sesamoid. It also rolls me to the outside of my foot so pressure is on the opposite side of the sesamoid. The thing is its uncomfortable. Do I assume its doing good and keep with it? Any pressure against the sesamoid at all is uncomfortable to me. Is this normal?
It is my left foot.
thank you again

Sounds like you are in the right appliance. Yes, any pressure on the sesamoid will be uncomfortable and is "normal." How long this annoying injury lasts depends on how much you can stay off it unfortunately. A fair number do go on to sesamoidectomy, especially younger/active patients.

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

I will continue to try and rest it and do better about limiting walking. If I end up needing surgery, how is the typical outcome? I had originally seen a podiatrist that mentioned he does not remove them and instead drills into them and insert a osteoinductive material. I know more traditional surgical technique is removal. Do you have a preferred technique?

I definitely prefer removal. Most do very well with no long term sequelae at all if done properly. You may have an increased risk of developing a hallux valgus (bunion) deformity, depending upon your genetics, but this is not conclusive in the literature - only speculative. The biggest issue is *when* (if ever) to do surgery, and that should be a discussion if no improvement despite treatment after, say 3 months at least. Another opinion not a bad idea as well.

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____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

As I have sesamoiditis in my right foot since the end of june and it doesn´t go away I wanted to ask if you found something that helped you? I stopped running entirely but kept cycling which I guess is bad for rehab. I still swim but try not to push off the wall with my right foot. While cycling I do not have any pain but if flares up the day after I guess. I am not too sure what else to try, I got a custom insole and used a pad aswell. I never walked barefoot and only got sesamoiditis after increasing my running volume. The medial sesamoid is bipartite confirmed by an MRI but not fractured. Anyone got any advice? I am debating a full cast for 4-6weeks and no cycling nor a lot of walking for that timeframe.

Just wondering how your recovery went. I dealing with this injury now...I similarly have a bipartite sesamoid confirmed by MRI but no fx. Thanks.