Question:I never ran before April of last year. I then trained for and ran the
Columbus Marathon (November 8) and got hooked on running in the process.
I noticed some pain in my left foot beginning about a month after the big
race, after having worked up to runs of no longer than 4 miles (my goal was
to run four miles as a base until I came up with another, more specific
goal).
My doctor checked it out in mid-Dec, and an X-ray showed nothing. He said
it was probably tendonitis, but that I should come back if it continued to
bother me after about three weeks of rest, ice, and ibuprofen. Given the
holidays, ski trip, so forth, I didn't end up back at the doctor until
February. He sent me to a podiatrist.
The podiatrist X-rayed my foot, and, a sesamoid bone that's been
fractured. (From the multiple angles of X-rays he took, it looks like in
more than two pieces.) He says that this type of injury can result in some
chronic pain (if you use your foot more than I've been) which may ultimately
require surgery. Apparently, these little bones never heal on their own.
The best result is achievement of a stable situation in which you do not
have problems with pain. The worst is the surgery.
Any thoughts, comments, experiences will be appreciated.
Answer:Sesamoid fractures are a bitch. I've never had one but I am a
podiatrist and have treated a lot of them. This is one of those
injuries that you will continuously reinjure while you are trying to
heal. As with a lot of sports / overuse injuries bargaining comes into
play - a lot. It will begin to feel better - you'll figure it is
healed - you'll run - you'll be symptomatic again. This goes on,
usually, for a year or more.
I try to treat them aggressively - such as using a below knee walking
cast for 4-6 weeks. That is pretty much what it takes - but most
people - especially runners - don't want to do that. I haven't
utilized surgery. You might want to get a second opinion before doing
that! There are two sesamoids one is medial (closer to the midline of
the body) and the other is lateral. Most sesamoid fractures involve
the medial sesamoid. If that bone is removed surgically the 1st
metatarsal phalangeal (big toe / foot) joint becomes unstable and you
might even develop a bunion as a result!
Taking anti-inflammatory agents, pain medications, and steroid
injections may improve symptoms in the short term but are ultimately
counterproductive. If you decrease the pain you just increase the
stress you place on the sesamoid and increase the reijuring of this
little bone. This is why these things tend to go on and on and on.
In general I would say that a sesamoid fracture (which, incidentally
is best diagnosed with a *bone scan* - x-rays can be deceiving and
inconclusive in these cases) is an unfortunate injury that is often
resistant to treatment.
