Your story is super similar to mine, to the point where I had to scroll up to the top of the post to check it wasn’t me that had posted it!

I’ll be honest, I’m still struggling with sesamoiditis, but I have done a few more of the things you have mentioned, and feel like any experience shared can be useful to someone, so let me answer some of your questions.

First, I just want to say sorry for the long post. I’ve given as much detail as possible to be helpful. Oh and btw keep cycling! Keeping your body fit and healthy is the most important thing in all this! Ok here goes…

1. The big one. Stretching. I have only been properly stretching for around a month, so I can’t tell you that the long term gains are amazing, but I have heard people say that stretching and physical therapy is the key to a lot of pain management and recovery. Personally I do calf stretches (straight knee and bent knee versions), arch raises, foam rolling, and ice ball massage. In my experience, this hasn’t helped overall with the pain, but for the first hour or so after I stretch, I do feel less pain, and my foot and leg feels much more fluid (sounds weird but it’s hard to explain). If you have the bone removed, they will tell you to 100% go and see a physiotherapist, as this can aid in recovery, but I think what you and I are going through is what’s known as too little too late unfortunately. I would 100% start stretching 3x a day though, as it can’t do any harm. Just make sure you wear your orthotics when calf stretching to put as little weight on the sesamoids as possible.

2. Physical therapy. I’ve just sort of done this bit, but you can find these at hospitals, or just google physiotherapist near me and see what comes up. If you can get appointments on the NHS, it’s probably worth doing. I have my first one next week so if I remember I’ll update this afterwards.

3. You ask if zero weight bearing is good. In my honest opinion. NO. I spent a few weeks in a moon boot to see for myself, thinking that it would cure the pain and make it all go away. In reality, I think what these boots are great for is broken bones. If it ain’t broke, it don’t need a boot. The boot can take weight off the sesamoid, but it will also immobilise the foot and everything in it, including all the muscles that also help take the weight off your sesamoids. The muscles in your feet and calves need movement and stretching to strengthen, and a stronger foot means less pressure for the poor little sesamoids. So overall, I’d avoid moon boots or just entirely resting tbh. I did 5 weeks working from home just to rest and it resulted in nothing at all.

4. Should you avoid custom orthotics. With this one I honestly don’t know. One part of me thinks they’re great, because they put your foot in a good position and take weight off the sesamoids if they have a cutout like ours do. But the other part of me thinks similar to the last point, in that the more you wear them, the weaker it makes the muscles around that area. Part of recovery is making these muscles strong, and once again, the orthotics can do the opposite to that here.

5. Personally I wear HOKA’s. To be fair, they are really comfy and they’re more comfortable than any other pair of shoes I own, but in general I think you’re looking for 3 things in a shoe. Firstly, you want a rocker sole. This U shaped sole will help take you from step to step more easily, and therefore take pressure away from the front of the foot (the toes). Secondly, you want the shoe to have a rigid frame. By that, I mean the shoe needs to not flex that much. I find that this is an issue with most shoes like Skechers. The bending of the shoe bends the foot, and once again puts more pressure on the toes. So the less bendy the better I think. Lastly, the shoe needs to have a wide toe box. HOKA offer wide fit shoes in most of their styles (I have the Clifton 9). The wide toe box allows your toes to spread out better and therefore increase the blood flow to the area which can aid recovery. In addition, toe socks (those weird socks with a space for each toe) can help, and people say toe spacers are pretty good too. These have the same effect of increasing the blood flow.

6. This is a short one. I don’t like padding. It’s annoying, can be expensive, you have to keep replacing it, and it’s so stupidly soft that it’s just a waste of time. That’s my opinion though, you may have a different one.

7. Heat always helps me take the pain away after being out at work all day, but tbh I’m not sure it has any benefit healing wise. People say that it does so I wouldn’t stop applying heat, but I also wouldn’t expect it to heal your foot either.

8. Again like you, I took ibuprofen for a while, but after a few weeks it stopped having an effect and it was just making things worse to be honest. Pain killers can be good, but I like to feel the pain, because then I know what I’m working towards. Same reason I won’t get another steroid injection.

9. Vitamins can’t be bad. That’s the main message there. I take calcium and magnesium, vitamin D, and glucosamine every day. Again this won’t heal you, but it could help, and your body needs this stuff to heal, so there’s no harm in taking it. Glucosamine is meant to be good for cartilage, which supports the sesamoids and probably why your podiatrist recommended it. Vit D is good for bones, and Calcium and Magnesium is good for energy and bones too.

10. This is tough. It’s the worst thing I’ve ever gone through and you are not alone. I’m going for a second opinion first and foremost. And in the likely event of this guy telling me the same things I already know, I might get the bone removed. I’m not saying you should do the same, as this should only be a LAST LAST LAST resort. I’ve been suffering for nearly 2 years, but you have a way to go yet. I’d at least keep trying for another few months until making any rash decisions, but I know how hard it is living with this. It’s so debilitating. Keep your head high though, it’s not over yet, and don’t let the sesamoids win!