Foot Surgery: Does a Sesamoidectomy Mean the End of My Running Career?

The best laid plans of mice and ultrarunners….

My surgery was supposed to be a rather routine operation on my right big toe, but things didn’t go exactly as planned.

Let’s back it up a bit and I’ll explain how I got into this mess. I’ve been having pain in my right big toe for about 18 months now. Actually, probably longer, but my memory is a bit fuzzy. I just considered the pain a ‘mild annoyance’ that I just had to deal with until I was walking down a hallway one day in high heels and caught sight of my reflection in a glass window. I had no idea how much I was compensating for the pain – even just walking around – until then. Because of the pain in the big toe joint, I was walking on the outside portion of my foot and sort of rolling my leg around to avoid bending the toe… I started to think – if I was doing that walking, what the heck was I doing while running??

I went to a podiatrist in New York, who took x-rays and concluded that I had ‘capsulitis’, or inflammation of the big toe joint. No problem. He gave me an injection directly into the toe joint of a mixture of corticosteroid to reduce the inflammation and ‘hyaluronic acid’, which can best be described as ‘lube’ for your joints (boys, keep your minds outta the gutter). The shot worked like a dream. The pain went away and my toe joint could suddenly bend like normal. Score! I was back to strutting around the office in pink high heels in a matter of days. And oh yeah, I could run normally again.

A couple months later I was back to square one. I went back to the podiatrist and asked about the risks of getting another corticosteroid shot. You see, the benefits were pretty clear to me. The injection goes right to the area of inflammation, which makes it more of a ‘targeted’ treatment than simply taking anti-inflammatory drugs orally (such as aspirin). The shot has a strong and powerful anti-inflammatory, and while it doesn’t reduce pain directly, it usually does indirectly by reducing the swelling and inflamed area. Plus, you get to freak people out by telling them you’re on ‘roids (kidding).

Okay, so onto the negative side effects. Other than the usual possible side effects of any injection (eg. infection at the injection site), there is a reason not to take corticosteroid injections lightly. Tendons can be weakened by corticosteroids when the injection occurs near the tendons, and in rare cases can lead to rupture. FYI this is why corticosteroid injections are not used around the Achilles tendon!

Okay, well, I wasn’t going to get an injection near a tendon – it was going to be localized in the big toe joint – so that wasn’t going to be a big worry. The main thing I had to be concerned about was the long-term effects of repeated steroid injections. Multiple injections into a joint over time are not advisable, as this can cause thinning of the joint cartilage, weakening of the ligaments, and damage to the soft tissue… Most podiatrists will limit the number of injections to three or four, but I figured I was okay with two. The second shot worked brilliantly again and helped me get through my first 100 miler (leading to my first win of a 100 miler!)

Fast forward to March of this year when I was experiencing pretty significant pain (again) in that darn right big toe joint (fancy name: 1st metatarsophalangeal joint, or MTP joint). I went and found a very well-respected podiatrist in London, Dr. Simon Costain of the Gait and Posture Center, who has over 30 years of experience and has previously worked with the British Olympic team. I felt comfortable putting my feet in his hands (so to speak!) and discussed my options. We agreed that there was very little flexibility in the joint and given the fact that the Australia race was just a few weeks away, there wasn’t much time for other conservative forms of treatment. Steroid injection number 3 it was…

Unfortunately, this injection didn’t have any effect on my pain. This is actually quite common – the more injections you get, the less effective they become. Darn it! I was running out of options.

I went to see Steve Bessant, neuromuscular guru who is CHEK certified, and he found that the tendons that were connected to the big toe were much tighter on the right than on the left. Perhaps that was contributing to the inflexibility of the toe and the pain! For those anatomy buffs out there (if there is such a thing), there are two tendons  associated with that big toe joint: the flexor hallucis longus (“A” in the diagram to the right), which brings the big toe down/flexes the foot down, and the flexor hallucis brevis (“B” in the diagram to the right), which brings the big toe down.

The manual work that Steve did helped improve the flexibility of my toe somewhat, but darn it, the pain just wasn’t going away. So finally, the week before I left for Australia, I went back to Dr. Costain to pull out the big guns. He said there was one more injection I could try – it was a stronger corticosteroid, and while it wasn’t ideal to rely on drugs as a long-term solution, we thought it might help get me through the race.

As you all know, I did make it through the race… but it wasn’t without pain. I guess I just figured it was the usual form of pain associated with ultrarunning. Hmm. I probably just forgot what normal felt like because the pain had been there for so long, increasing over time. Looking back on it, I realize that I had started to avoid walking even just a couple of blocks during the day if I could. I could block out the pain when I was in training, but there wasn’t anything I could do to distract myself during my normal day-to-day activities. I suppose that should have been a warning sign….

When I got back to London, I went in for x-rays on my foot to see what was really going on. Much to our (pleasant) surprise, the joint space in the big toe was much better than we thought, but we thought we should get an opinion from Dr. Lowell Scott Weil Sr., an expert foot and ankle surgeon based in Chicago, to see what my surgical options were.

Dr. Weil saw that there was some deformity in my right big toe. If you look closely at my x-ray above, you can see that the right big toe angles in toward my other toes more so than the left big toe (fancy name: hallux valgus). Dr. Weil said it didn’t look TOO bad, but it sounded like I had tried all other methods (orthotics, manual therapy, injections) and surgery would help.

Off I flew to Chicago for a simple ‘scarf bunionectomy‘, which involved cutting the bone of the first metatarsal and repositioning it with titanium screws so that it is more in line. If you want to see an animated video of what that entails, click the link! (Oh fun – what a glamorous life I lead, eh?) I was seriously worried about going under the knife, but Dr. Weil came so highly recommended that I knew I was seeing the best. I would make a full recovery and get back to running in a number of weeks.

I was in good spirits while waiting to be wheeled into the operating room. I tried to ignore the sounds of the saw cutting through the bones of the patients before me (EEEK!) and concentrate on my suduko puzzle in front of me. The staff at Dr. Weil’s clinic were AWESOME – very down to earth, funny, and willing to answer all of my inane questions. I joked with Dr. Weil as the anesthesiologist put me under… and apparently I kept chatting away throughout the whole surgery about running with horses in Vermont and also about this blog! Hmm, I wonder what else I said????

When I woke up, I asked Dr. Weil how it went, and immediately got the sense that something went wrong. I saw him putting a piece of the bone that he had sawed out of my foot into a little container, which was to be sent off to pathology. The next few minutes were a little fuzzy, but I can distinctly remember asking a number of times if I could run again. “But I’ll be okay to run ultras again, right?” It wasn’t a good feeling, I’ll tell you that. I tried to stay calm and remain focused so that I could ask Dr. Weil all of the questions that were floating through my head, but all I really wanted to do was hide under the covers and sob.

Dr. Weil explained that when he went into the foot, he checked the underside of the big toe (the first metatarsal) and got a bit of a surprise. He found a “complete tear of the medial head of the flexor hallucis brevis tendon” and one of the other tendons was almost completely disintegrated. “Mushy” was the word he used to describe it. He also found that there were signs of ‘osteonecrosis’ of the tibial sesamoid bone. which basically means that the bone was dying from a loss or diminished supply of blood. The sesamoid bone was virtually devoid of cartilage and it had been grinding away against the ‘first metatarsal head’ (the big toe joint), which could be seen in an area measuring about 1cm x .5cm. Apparently not unusual for people with bunions, but unusual for someone at the ripe old age of 27!!

Dr. Weil had no choice but to remove my tibial sesamoid bone, clean out the bone chips and reattach the flexor hallucis brevis tendon with a suture…

All I could think was WHAT DOES THIS MEAN FOR MY RUNNING?? (Doctor, will I be able to play the piano again?). Dr. Weil said with a strong rehab program, he hoped that I would be able to run marathons again, and if I could run marathons, I could run ultramarathons. I asked him if I would be fast, and he said that was up to me. Fair enough! I told him if I could run again, I could win again!

I’ve been doing a bit of research to figure out  the implications of having a sesamoid bone removed. I had never heard of things strange little bones before – how important could they really be??? Turns out, a lot. If you look at the xray below, you may see two pea-shaped bones under each first toe. They look like little floating balls. These are the sesamoids – the inner one is the medial/tibial and the outer one is the lateral/fibular. They are located under the head of the first metatarsal (remember, the big toe joint) and in the tendons of the flexor hallucis brevis muscle.

So what do our friends, the sesamoids, do? Two things:

(1) They absorb impact forces in the foot and help with stability.

(2) They help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running.

Logic says that removing one of these important sesasmoid bones would  make the rest of my foot weaker/more susceptible to injury and also cause me to lose stability and push off strength. Hmm.

OR, I could think of it this way: those extra tendons, bones, and floating bone chips were just extra weight that were dragging me down. Now that I got them out of the way, I’ll be even faster in my next race. Um, yeah?

Well, anatomy lesson is over for now. I don’t know about you, but this has exhausted me. Only time will tell. In the meantime, I am mastering the art of hobbling around in my surgical boot, which is rather amusing given that it is about 4 inches higher than any shoe I could possibly wear on my other foot. If I actually want to walk around balanced, I would probably have to invest in a pair of serious stilettos to wear on the left foot. Between looking like a crippled hooker and a female pirate, I choose pirate. ARRRRRR!

My foot has turned brilliant colours of black, purple and green and I still don’t have all the feeling back in my toes… but I’m making progress. Think good thoughts!!! I’d love it if you’d comment on my blog sometime – I had no idea that people were actually reading this thing (I mean, other than my sister and my mom) until the Australia race. Thanks for all of your support!!

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86 Comments »

  1. Hey Caser, The good news is that if the loss of feeling in your toes is permanent, you won't feel the blisters on the next long run! Keep your feet elevated and your chin up! Luv ya kiddo! Matt

  2. You're a true inspiration, Stephanie and with your obvious willpower you'll be back running soon enough. I think you'll feel a lot happier once you can start doing swimming, cycling or some other form of low-/no-impact exercises. In the meantime, have a look at this vid: http://www.youtube.com/watch?v=YktczvB-XvQ&feature=player_embeddedIf it doesn't make you smile, I don't know what will! All the best,-a fellow Canadian runner in NW London w/ a long-term injury.

    • Thanks for the encouragement!! Ha, I suppose what I lack in common sense I make up in stubbornness aka willpower 😉 I’ll have to live through other people’s running for now so please feel free to post some of your own stories!

  3. hi,
    i am sorry to read about the surgery. I have been running with a mild pain on my sesamoid on my left foot since a 80km ultra in february. rest and anti-inflammatory drugs didn’t help. my next ultra is a month away and then one more on november. I am a little concerned about permanent damage and all the wrong advice doctors could send me off on.

    was your pain on the sesamoid or more in you big toe? If i press on my sesamoid I can feel the pain more than when running.

    all the best with the recovery. no idea what I would do if i had to stop running.

  4. I just read all the info on the toe op…. sorry to hear all the details!

    On the plus side you have had a definitive answer to exactly what was the problem.. (always good) and if the doc says you need a strong rehab programme to get running again, i can’t think of anyone that will do it better than you. You’ll be racing again before you know it

    Here is a legendary story from the Tour de France that should cheer you up

    1947: TOE THE LINE
    Apo Lazarides was a dedicated domestique (team rider) who would do anything for his team leader René Vietto – and proved it in 1947, when Vietto ordered him to cut off his toe. Vietto himself was already down to nine toes after instructing the team doctor to snip off one of them in order to ease an aching foot. Lazarides dutifully agreed to the amputation, and for the rest of his life he would walk with a limp. Vietto’s toe, incidentally, was pickled in formaldehyde and is kept in a bar in Marseilles

    • Hi there! Thanks for getting in touch! Recovery is slow, but to be fair, I ended up having a lot more work done than expected! I have no hesitation recommending Dr Weil. My podiatrist here in London (who is an expert in the field and has worked with the British Olympic team I believe) praised Dr Weil’s work. My podiatrist is pretty conservative when it comes to surgery, but he said he would trust his own daughter with Dr Weil. I flew all the way to Chicago just to see him. Pam, his assistant, is super nice as well and really great with questions. If you go to see them, tell them the crazy Canadian ultrarunner with the missing sesamoid says hi! (Oh and a little tip – Dr Weil is a total cookie monster, so if you’re happy with your surgery it couldn’t hurt to drop him off a batch!). Let me know how it goes?

  5. hello ultrarunnergirl
    how r u doing now? I hope and pray you are doing well. I have a problemn in my left foot (medial seasmoid) for over 1 year and my doctor has recommended to remove the seasmoid.
    I would like some more information please and also kindly suggest me about Doctot Lowell.
    Many THanks

  6. Hi Ultrarunnergirl,

    Reading your post regarding the removal of the sesamoid bone was very interesting for me – I’m due to have this surgery tomorrow!

    I’m having second thoughts and doubts whether it is the right option for me, but I have been suffering with this injury for over 5 years. I used to compete in non-professional but competitive sports several times a week being a sport junkie. I’m now… relatively inactive due to this injury, and it has taken several hospitals and more than 10 doctors through the NHS before I have been taken seriously.

    How is your rehabilitation going, do you feel like you are back to 100%? Please let me know.

    Thank you

    • I understand what you mean, JC. I suffered for 8 months before going to the doctor. He put me in a boot for 7 weeks, therapy for 4 weeks, a shoe insert and crutches. I have had very little improvement and just recently, he implied that since I am still saying that I am in pain, I must be lying. If the crutches don’t work, I will have to see another physician. Can you tell me what lead them to make the decision to remove your sesamoid bone? I hope all is well.

      • Hi there,

        This blog has always been on my mind to come back to ive just been so busy. I wish I had the boot and crutches after my injury I really it could have all been prevented at the time with that precaution. My big toe was hanging lower than the rest of my toes on my foot for the first 6 months and would get caught whilst walking causing extreme pain. The joint on the big toe was also permenantly swollen for around 3 years but eventually it became hard as the bone has spurred. I tried various things out of the NHS who did nothing to help me. When I went to Asia I did a unique acupuncture where a doctor would stab the inflamed area with a short blade repeatedly and then place a cup to suck out the blood followed by injecting stem cells to promote healing. I was advised of 6-10 sessions but It was quite brutal and I wasn’t sure if I trusted it so I only did two. I also did shockwave therapy where a machine would repeatedly hit the area this was also quite brutal and I only did it the once. Just over a year ago I heard of this magical healer in Taiwan who apparently cures people of all sorts of problems. I went on a trip there and saw him on a few occasions and he was very sure it can be cured (a combination of acupuncture and what seemed black magic). Nothing worked so I came back to the UK and went to a new hospital which seemed to believe me and take notice of my problem. The doctor wasn’t sure what to do and after trying steroid injections listened to my suggestion of removing it. He agreed, but also mentioned he’d never done it before which concerned me. I actually backed out on the day of the operation… I would have to live with this forever and it didn’t feel right. I still can’t play sports properly and virtually do none as I find it so hard to limit myself. I’ve gone off from your question a little but the answer was really I asked for the procedure. Previously other doctors suggested I wait and have my toe fused to my foot sometime in the future.

        Anyway hope you are going strong now and enjoying the running! It’s been really great reading about your journey.

        Best of luck and happy 2015!

        One thing I must say that helped me so much is these special insoles I had made. They are hand made by P&P in the UK. Without them I can hardly walk without aching/arthritic pains. They really are amazing and have got me through these 6 long years of injury!

  7. Hi there! It felt like a long recovery at the time, but I eventually got to a point where I felt okay. I still feel pain at times, but it is manageable. I was worried I would never be able to wear heels, run 100 milers, compete in multi-day events… And I have done all of them 🙂 It definitely has affected my biomechanics, which has caused other issues for me, but I didn’t have a choice at the time. This surgery is and should be a last resort, but it isn’t a death sentence by any stretch of the imagination. Good luck and let me know how you get on.

    • Thank you for your quick reply 🙂
      I’m going to talk it through again with the doc – Even though it has been 5+ years I don’t feel I am at the stage that it is a last resort. In fact, I was much more desperate a few years ago.

      What other issues did this removal cause if you mind me asking?

      It’s very motivational to see what you have personally achieved since having this procedure, and I hope I can achieve something similar!

      Really appreciate your advice 😀

  8. JC, when you say that you were more desperate a few years ago, did you mean that it stopped hurting as much after the bone died? Because if so, I believe this is what has happened to me. It is hard to commit to an elective surgery when the pain has diminished. It has been five years since my initial injury. But whereas I was severely limited by my pain before, I can do just about anything I want to physically now. The reason I still would want the surgery is because doctors seem to be saying that the bone will wear on the joint and cause arthritic achey pains. However, I am assuming that having a surgery and an absent bone will probably come along with its own aches and pains. My pain is at about a 2 on a normal day (and that is walking about 5 miles a day).
    If I am eventually going to NEED this procedure, I would prefer to do it now while I am young. Most people post their stories right after their surgery and up to about a year afterwards but I am curious to hear about people who had this surgery five or ten years ago because I am going to have to live with this decision for the rest of my life.

  9. Hello. I’m not sure about how long ago you wrote this but am curious about your recovery time. I am a student athlete on scholarship. I recently found out that I have sesamoiditis (sp?) and have been doing the conservative treatment (crutch, boot etc.). The pain keeps coming back. I am considering having one of my sesamoids removed but afraid of how it will take to recover and most importantly whether I will be able to compete again?

    Are you back running yet? How long was your recovery time? What affects are you experiencing with regards to being able to run?

    I’m not looking for advice; just your personal experience with having this surgery?

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  11. Hi! I had my tibial sesamoid removed from my right foot almost 2 years ago now. I was a competitive 5k-half marathoner beforehand (sub 1:30 half, sub 18 5K) and have slowly but surely been working my way back to healthy running ever since. I haven’t been able to achieve those fast times as I used to since I get injured within 4 months of training or so due to change in biomechanics (always working out the kinks). I have never read an account of anyone who has gone through what I did quite so closely (for the boot I would wear a wedge sandal on my left foot… for 13 months! I think I started a fashion trend) 🙂

    A dream of mine is to qualify for the Boston Marathon (3:35) but I want to run a sub 3:30 (and I am fully capable/willing to train at this level). I started training for the marathon 2 weeks ago, but all friends and family are vehemently against this big increase in mileage because of all the scary ramifications if i break my only functioning sesamoid. I guess being petrified of injury is the main issue I am dealing with and don’t know how to continue marathon training without the support of all those I care about.

    Can you share a little on your progression to marathons/ultras and how you changed cross training/supplemented running to prevent further sesamoid injury? Also any favorite PT exercises would be so appreciated! I have orthotics, a wonderful PT and am the queen of aqua jogging. I am a triathlete during the summers to build a base for fall XC and spring marathoning (fingers crossed). I just ran a 1:34 half marathon and am improving week by week, but have constant flair ups that scare me in terms of sesamoid issues… Any advice would be so appreciated! I certainly don’t want to give up on a bucket list dream of mine. Boston 2016, here we go, sesamoid or not!

  12. I endured 8 months of chronic left foot pain and injury before finding a doc who properly diagnosed me and removed my fractured tibial sesamoid… Along with my bunion. He also fused my second hammertoe, as I had a plantar plate tear… My foot went through A LOT. I have had about 5 cortisone shots in the past 2.5 years, as well as countless hours of PT, countless months of CAM boot wearing, and countless pairs of orthoses. I am still nowhere near where I’d hoped to be, especially as I over-produce internal scar tissue, and the fat pad in my left foot has worn down, causing my first metatarsal head (in the ball of the foot) to pain me most of the time… I am rarely pain-free. That said, I have been able to hike and snowshoe this past fall/winter, and will continue to press forward. I definitely have days when walking feels like a burden, though. It is SO difficult to find support for my issues, or even any MDs who fully comprehend this situation… If anyone else can share their chronic pain stories with me after enduring similar surgical procedures, I’d be forever grateful! 🙂

  13. Isn’t it amazing how you adapt to the pain? I suffered this injury 3 and a half years ago and it was misdiagnosed every step of the way until last week! The pain was something else when it started but after a few months it had died down to a niggly inconvenience. I was still playing soccer once a week and coaching regularly. I also did the walk on the outside of the foot thing and I can tell by looking at my left shoe compared to my right that it is a habit that has stuck with me. I’m actually flat footed so it’s a weird combination. Usually a person with a high arch will suffer from this injury. At the moment I’m in a cast and on a boot for four weeks and hopefully that will do the job. I really hope the bone isn’t dead and that it heals but as someone who has suffered with poor circulation and allowing it to be injured for so long I don’t hold out much hope. I’m preparing myself for the bad news so if it is good news, then I’ll be elated. If it’s bad news, then I expected it.
    I’m on 26 too so this is a bummer!

    • Hang in there! I will keep my fingers crossed for you. Interesting – I have a high arch and poor circulation, so maybe that is why I got this injury… It has been years since the surgery though and I’m doing great!! Keep me posted on your progress 🙂

      • The cast didn’t work at all. 😦
        What a waste of four weeks. Have my new orthotics and I’m sorer now than I have been in a long time. Hopefully I’ll have my next appointment soon.

      • Hey there how are you doing now? Wearing heels and running? How long did it take for those things? I am in the same situation and very much in despair….thank you!!

      • Hi! I am doing both – wearing heels and ultrarunning up a storm. I still feel pain sometimes, but hey, ultrarunning is painful 😉 It hasn’t stopped me from doing anything. Keep your hopes up!

      • What happened to the tendon that enclosed the sesamoid that was removed? Was it attached to another bone? How long before you were able to run again? Do you wear orthotics with your heels?

  14. I broke one sesamoid four years ago in my right foot. I was able to ‘fix it’ with six weeks in a boot and six weeks in a cast. About two years later, I fractured the other sesamoid in the same foot. My doctor went ahead with the surgery. I have been in a cast and boot again, and graduating to sneakers soon! I would like to know, for others that had this done, was the procedure performed on the top or bottom of their foot? Mine was the bottom, and I still have a lot of swelling six weeks post op, but I am doing great in the boot. I figure I will never run again, but I would like to be able to exercise without the pain I had before all of this.

  15. My feet hurt! I’ve had sesamoid pain in my right foot for over a year now. It ranges from excruciating after use to a constant and unbearable nagging pain. I’ve had physical therapy, massage, used various orthotics, two cortisone injections, and still have pain. I’ve been to four podiatrists. I’ve had X-rays, MRIs, cat scan, and recently a bone scan. My right tibial sesamoid is fragmented (shattered) into multiple pieces, and now the bone scan results confirm that all of the bone fragments are “non-union” and dead, meaning they will not heal.

    I also have high arches, bilateral hammertoes, halux varus, flattening of the 2nd metatarsal head, subluxation of the DIPJ, heel spurs, and haglunds disease! One of my podiatrists said that, “if I was a horse, they’d shoot me!” Not a reassuring statement from your foot doctor! Limping and favoring my right big toe has altered my gait and caused back pain, which I have worked through. Now I am getting plantar fasciitis in both feet from favoring my right sesamoid. The heel and arch pain on top of the sesamoid pain is driving me crazy!

    I now have sesamoidectomy surgery scheduled, and have been reading all about it. What I thought was a simple straightforward surgery, I have learned is far from the truth. I’m reading about complications, post surgery deformation and bunions, extra long recoveries, continued constant pain, loss of balance and coordination (which is really concerning for me as a surfer), and not being able to return to previous levels of activity. Now I’m very anxious. My case is pretty clear cut that I have to have my tibial sesamoid removed, and I am confident in my podiatrist experience having done hundreds with good success.

    Perhaps more people post online when they have negative experiences. Can anyone chime in with similar experiences and touch on their recovery, how long to heal, rehab, post surgery pain levels, balance issues, what helped and what didn’t, etc. thanks.

    • I’m 3 months post op. I can wear shoes…flats, boots and running shoes with no problems. I’m even working out. I do have bursitis I’m trying to overcome in my hip on same side as my sesamoid removal. I was in a cast for 14 days followed by a boot for several weeks. I was in PT twice a week for about 6 weeks. My balance is good and the pain is minimal. I’ve done the elliptical, some kickboxing w some modifications, hot yoga and with little discomfort. I am no way close to running tho. My whole body is just different w the way I walk etc bc I waited years to have this done. So far, I’m glad I did it, but I know I’ve maybe run my last marathon years ago. Good luck.

    • Hey there! I had sesamoidectomy surgery on my left Fibular sesamoid last May! Recovery was not nearly as quick I had expected but it’s getting there. I just recently started running again, very low mileage right now but am signed up to run a half marathon in October. I’m not competitive runner, just a leisurely one 🙂 I haven’t noticed any balance issues or major complications. I still have to be pretty particular on the type of shoes I wear, definitely no heels or flip flops. If given the choice, I would have the surgery again. The pain before (my sesamoid had completely died and was fragmented) was far, far worse than the occasional aching I experience now. I hope your surgery went well, and you’re healing quickly.

      • Hey there,

        I was wondering if you could describe the pain you felt before the surgery?
        I’m 24 and have had big toe pain for 4 years in my right foot and a few months in my left one. I have localised tenderness under the toe joint, an annoyance, type of twinge pain. They swell often however and I find it sore to extend my toe and place pressure (lunges are OUT). I haven’t been able to exercise for 4 months now and walking is a chore – I’m very depressed actually. Can these type of problems show on an xray?

      • Hi Stacey! We really thought the pain was just from the bunion I had as my big toe had VERY little range of motion, so I was mainly concentrating on the pain in my toe, not under the ball of my foot. We didn’t even know I had a sesamoid issue until the surgery. Yes, lunges were definitely out! I realized I was actually rolling my foot a bit and walking on the outside to avoid having to put pressure on my toe. Doctors SHOULD be able to see a sesamoid problem on an xray, but I was seeing foot experts and they missed it. When they went back to the xrays after they discovered the problem mid surgery, they could see it in retrospect. I had made the mistake of getting steroid injections in my toe to improve movement and reduce pain, which worked the first time, but the second and third had almost no effect and probably turned my tendons to mush. I believe that if the problem had been caught sooner, it might have been manageable… Definitely seek some advice. You have to push doctors sometimes – be your own advocate. Do your research and go in asking about potential sesamoid issues. Don’t just take no for an answer. You can get back to sports – I know it!

  16. Hi, I have a pretty severe case of sesamoiditis and I’m a runner too. I’m at a point where I have two options: sesamoidectomy or reconstruction of the foot. I’m just curions to know if you’ve been able to run again since you got your operation?

  17. I am currently waiting a couple months before my Doctor decides to do surgery on my foot, ive had pain for about 19 months until one day i couldnt walk. My bone is not getting blood and its supposed to be dying, They sent me a machine i put on my foot everyday for 20 minutes to see if we can prevent surgery and im really scared, i would love to hear how was recovery for you and if you were able to run again

    • Hang in there! I’m made a full recovery. As you can see from the rest of my blog, I’ve been ultra running for years now since the surgery – woohoo! I still have some minor pain and can’t wear the flattest shoes sometimes but all in all no major issues. I know it is stressful but it is possible to run again!

  18. Hi Ulre Runner girl. My name is Wendy an I am in California. I am considering a bunion surgery with removal of my tibial sesamoid. I am wondering how you are doing related to not having that sesamoid. Thanks…..Wendy (wnb175@yahoo.com)

    • Hi Wendy! I know others have had bad experiences, but I’ve been totally fine. Recovery took a while and I still felt pain on the ball of my foot, but it has been years now and I’m ultra running up a storm 🙂 It changed my gait and my running style, but once that was worked out I was fine. Do your research on surgeons and make sure you trust yours! The bunion surgery I had was a scarf bunionectomy.
      >

      • Hi Ultra Runner Girl, would you please elaborate a bit more on how did the sesamoid removal change your gait and in what sense does it feel different? I think I am headed there because of post-traumatic arthritis of the sesamoid, and the biomechanical implications somewhat scare me, I cannot imagine not being able to participate in sports.
        Thanks …. Jorge

      • Hi there! I am not sure how exactly it changed my gait… but I don’t think it did for the worse. I had gotten so used to running almost on the outside of my foot to avoid the pain that I had to retrain my myself to run ‘normally’ again. To land on the balls of me feet and try not to avoid it. It took a while to not feel pain under the ball of the foot, and it is a bit more sensitive, but it truly does not affect my running now. I also had bunion surgery at the same time which shortened my big toe and affected my flexibility temporarily, but again, no issues long term! 🙂 hope that helps!

        Sent from my iPhone

        >

  19. I am trying to decide if I should get my fibular sesmoid bone removed. I also have Avascular Necrosis. My bone is completely dead. I am going to see my second othropedic sergeon on Wednesday to talk about options. Good luck with your recovery! I have a friend that had one sesmoid bone removed on each of her feet. She says she doesn’t have any pain now and is fully recovered. It took her six months to feel 100%.

      • Do you wear custom orthotics in your sneakers? Do you wear heels? Do you know anyone who developed a keloid on the incision? I have a fractured sesamoid with AVN and my surgeon that most people who have their sesamoid removed have problems later on. I’m really conflicted because I’ve read many success stories online, including yours.

      • Hi Annie! I do wear orthotics, but not for the sesamoid (I have an over-pronation issue). I really haven’t had any problems after the surgery (knock on wood – it has been quite a few years now!). I think try everything you can and if the pain doesn’t go away, think seriously about the surgery (and pick your surgeons carefully!) 🙂

  20. Hi all,

    I’m a 20 year old ~former~ runner who has had sesamoiditis in both of my feet for just over 2 years. I had x-rays done at a foot clinic, got orthotics with dancer pads, and went to physical therapy. I have also tried to rest my feet for the past 2 months. My left sesamoid is worse than the right. Unfortunately, every time I walk on it to go to the store or something, it seems to get irritated all over again. I have raynaud’s which causes reduced blood flow to the foot and sometimes my feet/toes even turn purple! I’m hoping to see a dr regarding this issue to see if increasing the blood flow would help with healing. However, I am worried sick about my injury! How will it ever heal if I have to live my daily life? What if I have to wear dressy shoes for interviews and for jobs someday? How can I live my whole life this way and never being able to run or exercise again? I struggle with an eating disorder and fear weight gain from cortisone shots, but don’t know if they will be recommended to me when I see a doctor. Have any of you gained weight from cortisone shots? Or had the cortisone actually heal the injury for good?

    My email is brunola@umich.edu Any pointers or just support would be greatly appreciated:)

  21. Hi Stephanie,
    I am a marathon runner and I have been developing sesamoids problems, I was not able to run painless for the last 5 months, with a break of 2 months, I hope to come back as you did, I am starting to be very worried about this injury.
    On Thursday I will see a well known sport podiatrist in London to see what we can do.
    Daniele

      • Hi all,

        Today I went to see an orthopedic surgeon and sadly he told me that I probably won’t be able to run long distance anymore for the rest of my life and that I cannot expect my sesamoiditis to heal completely on each foot, and I don’t even have severe pain. Hope everyone gets treatment as soon as possible because this is hard news for me to swallow.

      • Is the doc removing the bad sesamoids? With mine removed, I still don’t /can’t run like I did…marathons and 1/2s.

      • Sorry to hear that Amy! How far can you run? Can you wear high heels without problems? My ortho discouraged me from surgery…he said it’s hit or miss and did not recommend surgery, so he’s not going to unless for some unforseen circumstance in the future.

      • So, you have two sesamoids in each foot. Three years ago, I broke one, and my doctor was very against surgery. I wore a boot for 6 weeks and was non weight bearing and then it was followed by two casts for six weeks each and then the boot again. He said I was fine. Maybe I was, but then I started having major problems with the other one. He agreed to just take it out. I did that exactly a year ago, and I am pretty happy with my decision. I can run 2 miles, I can wear stupid shoes…maybe not as long as I used to, but I am better than I was. The recovery isn’t easy or fun, but I am better than I was.

      • Hi Amy, do you mean specifically that you fractured your sesamoid? From now, how many years ago did you have surgery? Were you in severe pain before the surgery, or did you opt for surgery due to it impacting your life like not being able to wear normal or dress shoes when necessary and not being able to exercise? Or did you get the surgery because you were in severe pain? I’ve never been in bad pain, it’s been pretty nagging and dull for me but that’s because I’ve avoided basically all situations that would cause it to hurt, which isn’t an option for me anymore because I have to have a job, etc. someday. I’m glad that you feel you made the right decision…sounds like you tried crutches, boots, etc. so many times! I haven’t done that yet

      • I fractured the first one. On the second one, it never showed as fractured, but the doctor could press on my foot where the sesamoid is, and I would go thru the roof. I couldn’t wear any shoes that weren’t flats. I am 5’2″, so that wasn’t fun. I decided on the surgery b/c I wasn’t going the route that I went before b/c I live alone, and the process took forever. I also did it b/c I was 42, at the time, and I have always been very active. I am not the best at running, but I loved it and love to workout, and I wasn’t able to do that. Def, invest in great orthotics. I don’t see your pain/nagging getting better. I was also in physical therapy numerous times. The bad thing is…the sesamoid deal isn’t so common so people aren’t familiar with it. Also, keep in mind, you can live without it…it is like your appendix. I don’t know if it is ideal to lose both in the same foot tho. I just had the surgery ONE YEAR AGO!!!

      • Do you see yourself being able to run longer distances in the future? Is it that you still feel pain in your sesamoid area? I got an X ray in March, then I continued to run on it and it got inflamed. I got another X ray yesterday except this time I was seen by an ortho surgeon instead of the unhelpful provider I saw in March. Ortho said my x ray this time was actually slightly better than in March. He thinks that my problem will be chronic but I’m hoping that since my feet belt better in Sept. than during Aug. and that my feet are now better than at the beginning of Sept., my feet will improve to some extent.

  22. I have never responded to a blog on the Internet. I see this was seven years ago and would love to know how you are now? Can you run? I have been offered the same surgery because I have a sesamoid bone fracture. All you talk about with your experience in this blog I completely relate to and am in the middle of it! I’m so weak on one side. I’m trying to run but end up crying, and it looks like my toe is getting even more weird looking. I have run many marathons and this is been my primary sport for many many Years. Can you run now??
    Jessica Wilson from Minnesota

    • I had a sesamoid fracture back in 2012-2013 that was so severe, I was in constant pain–as in, I probably did not sleep more than several hours most nights for months… I also ended up with a plantar plate ligament tear. I opted to have surgery to remove the sesamoid, fuse my second toe to allow the ligament tear to heal, and repair my bunion. It took a good two years to really come back from it (and I had a second surgery to remove hardware in 2014), and I still had fairly chronic pain for a very long time. Throughout the ENTIRE process, I still exercised, I just focused on my upper body and core as much as possible, and swam post-surgery. I still have issues, but have been running again for about a year and a half–I am slow, and I never run more than 4 miles, but I’m thrilled I have been able to run at all. I just have to proceed with caution and be good about cross-training. I will happily share more information about my (very) long journey if you are interested!

    • Hi Jessica! I’ve indeed been running for the last seven years… a lot! (My past and upcoming races are here: https://ultrarunnergirl.com/races/) So doing lots! Sounds like the situation you are in is really frustrating… are you getting good medical care? Make sure you see a specialist if you can and keep looking for the answers you need. If running is making you cry from the pain, that is NOT sustainable (or good for your body) – but don’t give up. Ask all the questions you can from the docs!
      Hoping there will be a good solution 🙂

  23. I know this post is quite old but there is so little useful information about avascular necrosis of sesamoids online! I’m a marathon runner just diagnosed with a ‘dead’ fibial sesamoid yesterday. I’m shocked – i thought I had turf toe and possibly a small bunion (no bunion! yay!)…the pain has been on the outside joint of my big toe and seldom under it. Weirdly, at this point, I’m not in pain. I had cut my mileage back significantly (down to about 20 miles a week for the last 2 weeks) and the pain and swelling in my big toe went away. I ran after i had the MRI (i know, runners are dumb) and it felt normal. My doctor told me to just get orthodics and see if i could ramp miles back up without pain. Is this right? I can just run on a dead sesamoid? It’s not fractured but I’m afraid if i keep doing my normal thing it will fracture and lead to a bigger mess.

    For anyone that has asked these questions to their doctors (i was too shocked too ask much in the office): Is surgery inevitable or can i really just continue running with a necrotic sesamoid? Is there any hope at all of saving the bone once it’s shown up as ‘dead’ on an MRI? And really, i can just leave a dead bone in my body for the rest of my life safely? I do have an appointment for a second opinion in two weeks, but i of course want to know these answers NOW so i know if i can just go ahead and keep running or if i should be babying this thing in hopes that it ‘wakes up’.

    Right after Boston last year I had an injury that i was afraid was a femeral neck fracture so i got an MRI, bone was fine but they saw a full thickness labrum tear. After much crying and wine, it turns out that it wasn’t the cause of my pain and I’ve had no issues at all with the tear. i’ll cross my fingers that i’ve had a dead sesamoid all along and i really did just have turf toe from my stupid decision to get flexible shoes and run hills a lot. (This is the denial stage of that acceptance curve isn’t it?)

    This blog is great and I’ve been a long time reader. I so admire your fearlessness. I did one ultra, got a bit lost around mile 21 and ended up in the middle of the woods, alone, vowing never again 🙂 I know you have overcome substantially greater injuries and managed to excel in this sport…you’re an inspiration to us fellow injured runners. thank you

  24. Can you give me an update on your foot. My 16 year old daughter is a marathon runner (aspires to be ultra) , is battling similar issues. She has a sesmoid fracture – which dhe also ran on for who knows how long. Anyway it is not healing and we are facing possible surgery. Trying to research other runners surgical results. Thanks for your great post. Hope you are doing well.

    • Hi Jennifer! As you can see from the rest of my blog, I’ve continued running hundreds (thousands) of miles and been able to compete at a fairly high level. Absolutely zero complaints from my side!! Hopefully this gives a bit of hope… when my issue was discovered, it was too late for alternative solutions, but definitely explore all options before surgery. Best of luck – I hope it gets sorted!

  25. Ultra runner girl, firstly you write very well! It’s 2.30am and I’m trying to find hope in what has been an awful 3 years with sesamoiditis. It’s not getting any better. Just wanted to know how you’re doing 7 years on? Thank you

    • I’m doing great!! Have just done three ultras in the last seven weeks and going strong! I can honestly say that my previous issues and surgery do not hold me back at all. I hope that provides a bit of hope!!! Good luck finding a solution and keep searching until you get an answer!

      Sent from my iPhone

      >

      • May I ask how bad your pain was prior to you going under the knife? Also without being invasive, would you be willing to meet me to talk through your experience in person?

      • Hi there! It was so long ago that I have a hard time remembering… but it was significant enough to affect my walking and running. I didn’t have surgery lightly – there were just no other options left unfortunately!

  26. Hi there, sorry for all the questions, however you’re helping a lot! Can you tell me why you went to Chicago to Dr Weil of all doctors? What Dr Weil a recommended doctor?

    I just find I have not come across Doctors that see this as a serious injury. It’s nearly been 3 years now and I really need to take action against my foot. Thanks

  27. I had my sesmoid bone removed on my right foot. My big toe ended up bending upwards and to the right. It’s not a huge difference, and the fact that I am out of pain made the surgery worth it.

  28. I have surgery to remove a sesamoid bone Monday. My foot has been hurting for 3 years and only an MRI showed a break and now osteonecrosis. How was your recovery? They are removing my interior sesamoid. Any advice?

    Thanks,
    Thad

    • Hi there! Everyone’s experience is different, but as you can see from my blog, I’ve been able to go on to continue training and competing in ultramarathons since. If you can get any kind of physio, definitely take the opportunity… at least do a checkin to make sure your recovery is on track. And try to be patient if you can! I still get some soreness where the bone was removed but it hasn’t stopped me 🙂 good luck!

      On Fri, Aug 11, 2017 at 1:30 PM, Ultra Runner Girl wrote:

      >

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  30. Hi,

    Several years ago I shattered the outer Desmond on my left foot. I was mountain climbing, I knew exactly when I did it.
    Walked and ran another year before giving in to surgery. The doctor removed the Desmond from the bottom of my foot. Healed nicely.
    I’ve always had foot pain, always. As a young women in my 20’s, I had a bunionectory on my right foot. The right foot, always in pain.
    Fast forward to today, the tendon at the site of the great toe moved left. The sesmoid is now floating, no tendon to encapsulate it.
    The burning and pain of walking has been eased with a boot. I’m considering surgery, I’m concerned about removing the inside sesamoid, I hate to have my big toe stand at attention. I won’t be able to wear closed shoes.

  31. I just had a fibulair sesoidectomy. I am very athletic and was in constant pain.when the surgeon went unheeded found my bone was in 11 peices.

    Does anyone have any information about there recovery?

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