stay with me because this may take a long time to explain...
I started to get a pain in the ball of my foot in March (just near my A-levels which wasn't helpful! I went to see A+E/GP/walk in centre, you name it and they all had different views of what it was from Arthritis to a broken bone etc so i decided that i needed to see a specialist as the pain was getting worse. The NHS were rubbish and said I would have to wait until November for an appointment and because it was so near my A-levels etc I decided to pay privately to go see a foot and ankle specialist. He said that because there was never a point of injury he thought it was a stress fracture from walking differently with my (badly made) orthotic insoles! He said I would need an MRI to see what was going on.
So around 3 months ago I had an MRI which showed Odemas (bruising and swelling) in my 1 metatarsal, 2nd and the ball of my foot. My doctor claimed it was a start of a stress fracture and now that I had stopped wearing these insoles that it should go away in around 12 weeks.

The pain got worse over the following weeks until I was unable to put my foot down at all so i decided to get a second opinion of what was happening on the NHS because I had waited al this time. This doctor claimed it may not get better due to the fact that I was still slightly walking on it and told me to non weight bear for 2 weeks ( which if anyone has tried is unbelievably difficult and very annoying and definitely decreases the quality of your life loads!) So then I developed this weird rash/redness with puss coming out of my foot after 2 weeks and went back to the NHS to see if everything was okay! anyways, this redness and everything is apparently a separate issue of a skin infection (which is a hell of a coincidence as it is on the same bone as my injury but anyways I don't have any reason to believe it is connected.) So turns out this guy had looked through my files and he has now come to his own conclusion that it was not the start of the stress fracture and that it is Sesamoiditis?! or a Sesamoid fracture? what confused me is why they dont know for definite as they did an MRI? anyways, now hes prescribing my orthotics and I have to wear a shoe with a rocker bottom sole and everything to keep the weight off my foot BUT now i'm feeling a little defeated because if it is something to do with the sesamoid bone I haven't put weight on that bone in nearly 5 months?! so how is any of this treatment going to help? he also said he was considering an injection? :l
Anyways, just wanted to know your opinion, or anyones? because getting to the point where this is seriously affecting my mood as I have been on crutches for nearly 5 months and keep getting told different things and nothing seems like its going to work! please help!

Thankyou for any help I get as i was in so much pain that I cry every night Sad
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replied August 25th, 2011
Especially eHealthy

The MRI is a wonderful study, but it cannot make the diagnosis for you. It is not like Star Trek, where you put the patient in the machine and it spits out the diagnosis.

It showed that you had some edema around the first metatarsal (but you did not say where, was it in the shaft or the metatarsal head?), the second metatarsal, and in the soft tissues around the metatarsalphalangeal joints.

But, it could not say what the cause of the edema was. That is where the history, symptoms, and exam have to come into play. And it is sort of like a puzzle or detective story, to find the answer.

Yes, being on crutches is very difficult. But, if you are having pain in the ball of the foot, you need to stay off that area, by whatever means. Be it crutches, rocker bottom sole, or a metatarsal bar.

As to the sesamoids, these are two small bones, which are embedded within a tendon, and act as a pulley. You have two sesamoids under the metatarsalphalangeal joint (MTPJ) of each great toe (and also in each of your thumbs). They do articulate with the articular surface within the MTPJ.

So, they can be inflamed and set up an intraarticular inflammation. They can fracture, just like any other bone (but beware of the bifid sesamoid).

Unfortunately, chronic sesamoiditis can be very frustrating. It can be very recalcitrant to any treatment. Even surgically removing them can cause problems. More than one athlete's career had ended due to sesamoiditis.

But, that may not be your problem. Do you have early bunions, metatarsalgia, a neuroma, Frieburg's infraction, general overuse syndrome, a dynamic biomechanical problem, etc, etc.

As you probably realize, more investigation is needed. Plain x-rays will show if the sesamoids line up properly or if one is broken. A bone scan may be the best test right now, because it will tell if there is any active inflammatory process going on in any of the bones of the foot, be it inflammation, trauma, infections, tumor, or metabolic. But, as with any study it is just more information, not a diagnosis.

Pain in the forefoot, under the ball of the foot can be very frustrating. hang in there and be persistent.

Wishing you the best. Good luck.
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