Well, I’ve felt a dull ache in my big toe joint for a couple of months but so mild that I thought nothing of it other just part of the grind of training. Then, last Wednesday, I felt sudden pain while running. I changed my gait a little and it went away so I kept running for another mile when it hit again, but didn’t go away. So, I walked home, iced it, and rested it for a week until yesterday when I tried to run again. I made it 100 yards before I knew it wasn’t happening and made an appointment to see a podiatrist. Went in today fully expecting to find out I had turf toe, but instead I have a fracture of one of the sesamoid bones. I have a three races this month starting this weekend… Doc said about 6 weeks healing time, but cut me an insert for my shoes to “float” toe and suggested that if it was really important I could race this weekend (a sprint with a 5k) if the pain was manageable. Thing is, I have zero pain except when I toe off while running. I feel it a tiny bit while walking. Does anyone have similar experience with this injury? If so, how did your recovery go? I am really disappointed at this point, as I am in the best shape of my life and was shooting for overall finishes in the next 3 races.
Here’s the x-ray:
I have broken sesamoid bones in both feet. At first the pain was almost unbearable,but I now run 5 days a week virtually pain free. I changed running shoes and went to Mizuno Wave Riders after using Asics and Nikes for years. The Podiatrist told me I had very high arches that did not help the situation. The pain comes and goes now and when it hurts its not that bad. Ice and some aspirin work quite well when needed. Good luck.
Can I ask where the fracture is?
See the two round things below the second joint of the big toe. Those are the sesamoid bones. The left one has a fracture through it.
See the two round things below the second joint of the big toe. Those are the sesamoid bones. The left one has a fracture through it.
ouch 
thanks for pointing that out. does that happen from repetitive impacts?
I have broken lots of bones. My right leg twice, all my fingers on my right hand at least once, my skull, my collarbone, my right foot metatarsals and 4 ribs. Oh yeah, my nose twice but it’s not a bone. Take some time off and let it heal. You will regret it if you don’t. I’ve always done my PT and stayed off my injuries except to promote range of motion. Everything is A OK and my friends are often surprised that I don’t have issues. Of course they are the type who won’t stop training. Like my bro and his 6 year bout with Plantar Fasciatus. If you are in the best shape of your life then you wouldn’t have a broken foot.
Your fractured tibial sesamoid is NOT likely going to heal at this point on X-rays (already what, 2-3 months old?). You will likely see that fracture line 6 months from now on films. Best to hope for is a fibrous type union there and no symptoms (which is really all that matters). These are often even incidental findings on X-rays for some other reason (assuming a fractured sesamoid and not a normally occuring bipartite one).
Offloading with a shoe cutout, orthotic, etc. a good idea, as is “relative rest” (i.e. no impact running, etc.). You are still walking around all day. Long term if no improvement, the general rec is removal of the tibial sesamoid - a relatively easy/uncomplicated procedure.
Best of luck to you.
X-ray is from today. I suspected the injury happened at the beginning of summer when I moved awkwardly walking on the bottom of the pool playing water basketball. Doc seemed to think the fracture was too fresh. Walking around there is no pain. A little pain climbing stairs but minor. Only hurts when running.
Also, if one sesamoid is removed but not both, how does that impact future running? I’m relatively young at 33.
Sesamoidectomy will usually not impact running long term.
I had a similar injury, orthotics took the pressure off my high arches & I have minimal problems with the injury now. I used to compare it to feeling like I was stepping on a marble when I walked.
I think you have a bipartite sesamoid, a normal anatomic variant, rather than a fracture.
That is not a bipartite tibial sesamoid. If symptoms dont improve non surgically, AND it keeps you from running, take it out.
Any chance you could also post the lateral X-ray just for completeness sake?
John
Only one was taken. Didn’t seem like the most thorough doc. Probably going to get another look at it by someone else, too. I’ve decided that running on it at all isn’t the best course. I rather get this healed up properly. I don’t know if this is normal for this injury, but the pain seems to be on the top of the foot, not the bottom. I can also press and prod all around with no pain whatsoever.
I have been having ball of foot problems for a while. My doc has tried all kinds of orthotics- nothing seems to make cycling pain free.
He referred me to another doctor that suggests shaving down the sesamoid. Is this viable? What is is recovery time from something like this?
Shaving down the sesamoid? If all else has failed and you are looking at surgery, sesamoidectomy is generally recommended rather than planing - at least in my opinion.
Thanks- I was looking for that kind of advice.
What is the recovery from removal?
This doctor recommended against bone realignment- said I would be off my feet for a very long time.
Thanks- I was looking for that kind of advice.
What is the recovery from removal?
This doctor recommended against bone realignment- said I would be off my feet for a very long time.
Depends on what sesamoid. Most commonly it is the tibial sesamoid and can be addressed from a medial approach. The fibular sesamoid generally requires a plantar approach and takes another week or 2 to heal.
Plan on 2 weeks in a surg shoe/boot with limited weight bearing. No swimming for 2-3 weeks. Cycling/spinning possible with caution around week 3. Running would be 6 weeks at the earliest. For your planning purposes only and many other factors to consider that only your surgeon can discuss with you.
It is tibial.
Thanks for the advice.
I am primarily a cyclist so getting back to cycling and gym work are my main concerns.
I wish you were in close proximity to me. I would use you-