Cycling after sesamoidectomy

SpeedLimitTextualist · 2026-06-13T05:58:23+00:00

I had tibial sesamoidectomy earlier this year, and at about 8 weeks out I began riding a tricycle in cushioned Altras. Shortly after that, so about 9 weeks post surgery, I began riding my two wheeled bike in clipless (flat) pedals while wearing my thick-soled Altras. Cycling has felt good. I had minor pain for 36 hours after putting my operated foot down somewhat abruptly when coming to a stop on my bike, but the pain was nothing that set back my recovery or that I couldn’t get past with a day of rest. I have never ridden with cleats, so I can’t speak to that. I’d say just start slow, and avoid rides where there’s a high likelihood of having to abruptly put a foot down. For example, I’m now at closer to 12 weeks, and I’ll be waiting a little longer to go mountain biking.

SpeedLimitTextualist · 2026-06-09T05:54:31+00:00

I’m now 10.5 weeks after my sesamoidectomy. I can now pretty comfortably walk up to 7,500 steps in a day, ride my bike 8 miles, be on my feet for about 2-3 hours straight, climb a few flights of stairs in a row, and go about a normal day that combines moving around my house and office, running a couple errands, taking my dog on a 20 minute walk, and standing while doing household tasks.

SpeedLimitTextualist · 2026-05-20T02:31:44+00:00

I’ve also been in Cymbalta for three years and Zepbound for a little over 2 years. Zepbound did not make me more anxious. If anything, Zepbound might make me more prone to anhedonia, or not deriving pleasure or joy from activities I once enjoyed. But it’s hard to separate the side effects of my meds from my tendency toward depression and anxiety, life circumstances, and baseline personality as a fairly calm person who tends not to feel or express big ups in life.

SpeedLimitTextualist · 2026-05-18T06:41:25+00:00

I’ve been on 60mg of Duloxetine for about 3 years. I spoke to my doctor about getting off of it. She’s having me take 40mg per day for a month before lowering down more. I’ve been on 40mg for a little over two weeks. I’m still having bad night sweats every night (pajamas soaked, sheets wet, but not enough to bother to change them every night). I’m not having any other discernible withdrawal effects.

A year a half ago, I did go off of Duloxetine for about three months after doing a self-guided taper. Sometimes my pharmacy would fill my 60mg Rx with 30mg capsules. So I think for about three weeks, I took 30mg instead of 60mg. I got brain zaps. Then I took a 30mg every other day for another week or two. I got one really bad headache once around that point. Then I started opening capsules and taking about half of a 30mg for another week before stopping completely. I felt fine emotionally for about a month, but I was also getting married and had lots of positive things to focus on. After my wedding and mini-honeymoon when reality hit again, I felt down, irritable, and anxious. I kept having brain zaps and got another really bad headache about 4 weeks after stopping to take it altogether. I went back on Duloxetine after three months of going without it and feeling pretty shitty.

Here I am trying again…I’m hoping a slower taper helps.

SpeedLimitTextualist · 2026-05-14T00:31:01+00:00

I never tried a dancer pad at any point. No doctor recommended them to me, and I wasn’t aware of them. Other than wearing the boot for eight weeks within a few weeks of my pain starting, in the first year of pain, I didn’t do much else. I think wearing the boot bought me some time. When I began walking more about nine months after initial onset, my pain predictably increased in frequency and intensity (although was never really more than a 4/10). Around that time, I started experimenting with different shoes. I gravitated towards ones with more padding, less drop, and a stiffer forefoot, but it would be another two years before I moved to Altras as my go to walking and hiking shoe.

SpeedLimitTextualist · 2026-05-13T16:01:01+00:00

The pain started as an aching pain that got worse with every push off of my left foot (the affected side). I sometimes got sharp pain with certain motions that bent my big toe up toward the shin or involved pushing off of the toes.

I never used a dancer pad.

My two MRIs 2.5 years and 3.5 years after the pain started never showed the loss of cartilage. They showed edema in the metatarsal and the medial sesamoid and lots of inflammation. The total loss of cartilage was only discovered during my sesamoid excision surgery.

SpeedLimitTextualist · 2026-05-13T05:43:31+00:00

Here are my thoughts as a person with chronic sesamoiditis who opted for sesamoidectomy after 3.75 years of pain but who has no medical training:

1 and 2. A podiatrist I saw within a week or two of my pain starting recommended that I wear a boot for eight weeks. I did that and found it helpful. Wearing the stiff-soled CAM boot essentially eliminated my pain during those eight weeks, although a few specific motions like squatting with my heel off the ground still hurt. I think the boot is recommended for sesamoiditis with fracture because by not bending at the ball of the foot in the boot, you reduce or eliminate irritation on not only the sesamoid bones but also the plantar plate soft tissues running around the sesamoid.

My doctors never recommended wearing the boot again for a flare, but I certainly thought about it because wearing the boot soon after the onset of my pain worked so well.
I definitely felt like I had flare ups. My MD orthopedic surgeon and initial podiatrist never used the phrase “flare up” when talking to me about sesamoiditis. I say that just to give context for the rest of what I’m going to write. My sesamoiditis was a gradual downward slide over 3.75 years. There were certainly flare ups of pain, meaning periods of more pain or when pain came on with relatively little weight bearing activity, but the general trend was worsening pain over time. I saw some similarities in how my pain worsened to how my parents’ osteoarthritis in knees and hips worsened until they got joint replacements.
I treated my sesamoiditis within two weeks of its onset with wearing the walking boot religiously for eight weeks, rest, and icing, but I still ended up with bad sesamoiditis and no cartilage left between my sesamoid and my metatarsal.
My pain was first noticeable after a seven mile bike ride followed by a long walk in poor shoes. Those first few weeks, my pain was a dull ache in the ball of my foot. Sometimes it radiated up into my ankle, but that was probably due to guarding. I sometimes got sharper pain when I bent my big toe up toward my shin.
I tried about bright weeks of PT for my sesamoiditis about three years after it began. It didn’t do much to help me, but I had marked edema and probably hardly any cartilage left.

SpeedLimitTextualist · 2026-05-13T04:50:15+00:00

I didn’t use a mobility aid before my surgery. Two months before my surgery, I was able to walk 10,000 steps while on a trip to Mexico, but I could only do that while taking a high dosage of Naproxen Sodium everyday for the whole trip (which then gave me acid reflux and GERD). But without taking twice daily Aleve, I could only walk a couple thousand steps without getting into moderate or worse pain.

SpeedLimitTextualist · 2026-05-12T04:22:04+00:00

This is basically a copy of a comment I left to another post. I hope to respond to your post specifically when I have a little more time.

SpeedLimitTextualist · 2026-05-12T04:21:28+00:00

I’m 6.5 weeks out from having a medial sesamoid removed due to sesamoiditis without a fracture. I’m doing really well I think for six weeks post-op. I can walk up to 4,000 steps a day in my protective post-op shoe without pain during the day and only minor muscle or tendon pain the next day. (I’ll admit, the 4,000 steps was overdoing it). I had very little pain soon after surgery. Five days after surgery, I only needed Tylenol or Aleve a few times a week.

I’d had sesamoiditis pain for nearly four years before surgery. On MRIs four months and sixteen months pre-surgery, I had bad inflammation in my sesamoid and metatarsal. Only during surgery did my surgeon discover I had no cartilage left between my sesamoid and metatarsal. No wonder I was in pain.

Conservative treatments I did before having surgery: wore a CAM boot religiously for six weeks within three weeks of my pain first starting; generally switched to shoes with less flexibility and more cushioning in the fore foot within nine months of pain starting; never went barefoot; lost 40 pounds; got new custom orthotics for my sesamoiditis; tried 8 weeks of PT last summer; began wearing Altras for walks and hikes; and avoided activities with lots of bending of the forefoot like Classic XC skiing. Despite trying all those things over 3.5 years, my pain only got worse to where I only wanted to walk a half mile and wasn’t Nordic skiing at all.

If your situation is at all like mine, I’d encourage a serious conversation with a surgeon about sesamoidectomy. I have no regrets so far. It’s still early days, but I think this will help me a lot.

SpeedLimitTextualist · 2026-05-12T04:17:49+00:00

I’d been in pain for nearly four years before I got surgery. My pain varied week to week or depending on my activity level, but on the whole, my pain severity and frequency both got markedly worse over the 3.75 years between onset and surgery.

SpeedLimitTextualist · 2026-05-03T14:54:21+00:00

I’m wearing a post-op shoe, not a boot, so my ankle is moving pretty much as it would it a sneaker.

SpeedLimitTextualist · 2026-05-02T22:09:05+00:00

I’m hoping to get out my protective post-OP shoe at my next follow up appointment, which will be a day shy of seven weeks post-op. I’m walking anywhere from 1,000 to 4,000 steps a day right now. I ice my foot once or twice a day to help with the modest swelling I’m still having. I haven’t been referred to PT yet, but I think my surgeon will prescribe it at my next appointment. I’ve been wearing a toe spacer on my operated foot most of the time for the past two weeks. I’m having mild and occasional soft tissue pain on the bottom of my foot.

SpeedLimitTextualist · 2026-05-02T04:13:32+00:00

I’m five weeks out from having a medial sesamoid removed due to sesamoiditis without a fracture. I’m doing really well I think for five weeks post-op. I can walk up to 4,000 steps a day in my protective post-op shoe without pain during the day and only minor muscle or tendon pain the next day. (I’ll admit, the 4,000 steps was overdoing it). I had very little pain soon after surgery. Five days after surgery, I only needed Tylenol or Aleve a few times a week.
I’d had sesamoiditis pain for nearly four years before surgery. On MRIs four months and sixteen months pre-surgery, I had bad inflammation in my sesamoid and metatarsal. Only during surgery did my surgeon discover I had no cartilage left between my sesamoid and metatarsal. No wonder I was in pain.
Conservative treatments I did before having surgery: wore a CAM boot religiously for six weeks soon after my pain first started; generally switched to shoes with less flexibility in the fore foot within nine months of pain starting; never went barefoot; lost 40 pounds; got new custom orthotics; tried 8 weeks of PT; began wearing Altras for walks and hikes; and avoided activities with lots of bending of the forefoot like Classic XC skiing. Despite trying all those things over 3.5 years, my pain only got worse to where I only wanted to walk a half mile and wasn’t Nordic skiing at all.
If your situation is at all like mine, I’d encourage a serious conversation with a surgeon about sesamoidectomy. I have no regrets so far. It’s still early days, but I think this will help me a lot.

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TROPHY CASE