I was recently asked for medical advice by a young lady, who had sesamoiditis for a long while. While she had heard various opinions on treatment for the condition, she noted that a very smart physical therapist told her the pain may be nerve-related.
The sesamoiditis is bilateral and the patient has noted that she has the symptoms when she goes from wearing orthotics to no orthotics overnight. There has been no visible swelling and magnetic resonance imaging (MRI) is negative except for some edema in the tissue around the sesamoids. She wore a pair of wedge-type shoes that put more weight on the sesamoids but noted this actually felt better than flats. The patient relates a general intolerance to shoes. At 49 years old, she has a documented L4/L5 stenosis with minimal back manifestations but disabling foot issues. Of note, her nerve conduction test was negative.
All these findings point to nerve pain. I told her to see a peripheral nerve doctor in her area who understands the double crush syndrome. I told her that nerve conduction tests document nerve damage but not nerve hypersensitivity. In my opinion, she may need an epidural or something more invasive for pain management but she could start with topical nerve creams like Neuro-Eze or Neuro One, nerve flossing, warm soaks or contrast (baths), B complex supplements, TENS units, looser shoes and no prolonged stretches along with learning how not to irritate the sciatic nerve. Perhaps her physical therapist could teach her that.
One of the golden rules I have learned about nerves is that all of the treatments to help can be irritating when patients first start to use them. In my clinical experience, while these treatments are beneficial for patients most of the time, I have seen other patients who say those same treatments are immensely irritating. In these cases, I try to modify the given treatment so there is less general intensity.
When treating a painful sesamoiditis, keep in mind that if your commonly successful interventions are irritating a patient, it could be a clue that the etiology is nerve pain.
Dr. Blake is in practice at the Center for Sports Medicine affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine.
Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.