The Tragedy of My Medial Sesamoid Foot Bone

I never thought I’d be writing an article about my physical deficiencies, especially when I’m a 23-year-old with enough internal energy to light up the federal power grid. However, the past few months have forced me to examine who I thought I was as I battled an injury I sustained nearly two years ago - and didn’t know it. This is the story of how I fractured my medial sesamoid bone in my left foot; it’s a tiny knob, barely perceptible since it’s tucked inside a tendon. My attitude towards this setback has varied wildly, from surprise and resilience to sadness and shock.

Only a few months ago, I was biking 30+ miles on the Hawthorne Trail in Gainesville, rollerblading in Long Beach, CA and bending my body like a soft pretzel during hot yoga. Activity runs in my blood and mends my mind as I’ve also struggled with anxiety and mild depression this year (a soup of COVID and parental/relationship issues). Without this physical cleansing, I have to reposition my thoughts and find strength inside myself, not through running away or sweating out my problems. Hobbling doesn’t have the same effect as sprinting does, but I have to remain positive that I’ll reach the finish line somehow, some time.

My timeline is muddled but the genesis of my fracture probably originated in the fall of 2018 - I had just moved to Arlington Square Apartments in downtown Gainesville and was thrilled that I could walk 20 minutes and be at the Gerson accounting building. It was legitimately magical; my commute time was cut threefold and I could blast music while lazily walking home down second avenue. I relished the sidewalk smells, the light sweat collecting on my neck and the charactors of Gainesville. It was the closest I had gotten to the city livin’ I glamorized and dreamed about for years. Except I wasn’t walking lazily and hazily - I was usually fast-walking in gray Converse or maroon Vans because I’m an energizer bunny with stuff to do. I was usually scrambling home - nearly running on air - to finish up homework, drive to a meeting, swing at the park, etc. If “stroll” is in the English dictionary, it definitely wasn’t living in my lexicon.

It was also generally a weird time - I was 20, I was cruising around town with wannabe Woody Guthrie boys and spending nights dancing at the High Dive. Foot health was the last thing on my mind; I was thinking about Alex Turner, music review deadlines and how supple my lips appeared in Burt’s Bees chapstick. I was roving around Gainesville like a manic robot, speed walking miles in shoes that had soles of gossamer (AKA no arch support whatsoever).

The area around my left sole started twinging in Spring 2019 but I chalked it up to bad shoes and low pain tolerance. I enjoyed long-distance walking more than any person I know (besides my mom and grandma, who I inherited it from), so I continued going between my apartment and class five days a week. My foot was aching at this point, but it was a dull constant that I acclimated to. I also began dating my boyfriend, Nikhil, and we’d walk miles at midnight. Past the darkly illuminated “Walker’s Furniture” sign, past the Asian food market and gas station that never carded - the cockroaches would crawl with us, inhabiting a space that was quiet and uniquely ours. My thoughts wandered to Nikhil’s smile or how happy and completely myself I felt with him, not the annoying ache in my size 6 foot. We owned Gainesville’s streets, especially on random Tuesday or Friday nights.

This pattern of denial and complete overextension of my (probably fractured) foot continued until December 2020. In the intervening months, I did intense yoga which stretched my foot tendons to taffy, walked kilometers across Athens, London, Rome, Scotland, Dublin and New York City, rollerbladed, ran and the list is never-ending. I hate slowing down and being sedentary. As I said previously, I am a canister of nuclear energy both in mind and body and I’m always cooking up a scheme that requires mobility. The idea that I should “take it easy,” even though I knew something was off with my foot, didn’t occur to me. Classic denial, classic Macc.

Fast forward to July 2020: I recently graduated from UF and moved to the 120-degree desert in Phoenix with one car and unsure expectations. I was trying out my “adult” costume and wrote “figure out foot problems” on my updated Goals List befitting for a working girl. I’m neurotic about checking off items on my to-do list, so naturally I made an appointment to get custom orthotics at a swanky North Scottsdale store. The lady proprietor wore a blue button down and had impeccable red toe nail polish - she was the casually affluent Scottsdale type, but I blindly believed in and bought her $350 Reebok shoes¹. Not a great idea - I was attempting to hike Camelback Mountain and failing miserably, my foot sore and pink in my sneakers. The orthotics were an expensive Band-Aid on a much nastier problem, but I was too scared and cheap to see a doctor - besides, I had PTSD from my recent negative experiences with doctors. I was shamed by one CVS nurse for needing antibiotics for BV, and admitting I was on birth control to my parents was similarly disgraceful.

However, the consequences for ignoring my foot were more serious than being called a slut or a hoe. My short-term goal is to be a crypto company co-founder and part-time yoga instructor in San Francisco, with my office and yoga studio sharing a building. As I was analyzing my crippled foot one evening, frustrated and hacking off my overgrown toenails, I realized something had to change - my dad had recently fractured his heel, so I made an appointment with his podiatrist for late December 2020. I was excited to recover and be strong again (I suspected I had a sprained right knee as well, so I wanted to kill two tendons with one stone).

The orange-colored doctor flexed my big toe and took an X-Ray as I sat content in the patient chair, brown leather peeling. It was like applying to a prestigious fellowship and feeling nervous/anxious to see if I got in - not knowing was almost better than complete knowledge, and the anticipation was sweet. I was convinced my Eureka! moment was coming and Hippocrates would cure my sad little foot. On a side note, I also felt awkward because my dad was in the room with me; we’re not on the best speaking terms and I have lingering anxiety from prior medical run-ins involving sensitive lady issues.

“Looks like you have a fractured sesamoid bone.”

“A fractured ses-a-what?”

Flabberghastion² was quickly replaced with “ahh that makes sense,” as I recalled the pain and discomfort of the past two years. Still, I was surprised my bone was actually fractured - and judging by the faint line separating the two smaller halves of the medial sesamoid bone, it definitely was injured. According to Foot Health Facts,

“A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint. Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe pushes off during walking and running.”

The medial sesamoid is directly underneath your big toe while the lateral one is slightly to the side - see below for my fresh-off-the-radiation x-ray:

The sucky thing about sesamoids (which are also present in your hands) is that they are miniscule bones inside tendons. Blood flow is more restricted to these areas, which prevents the bone from completely healing - and since my injury was 2+ years old, the prospects were not bright.

“What we can do is give you a cortisone injection so the scar tissue around the fracture breaks up and your bone can fuse together again,” said the Oompa Loompa podiatrist. His skin shone like a lighthouse beacon and his nose peaked out from under his loose mask.

What the hell did I know? So the man pulled out a sterile 5 inch needle, dabbed anesthetic onto the area and sunk the metal deep into my skin. Blood sprouted like a bean shoot but my face was straight as a pin; what is a cortisone injection to your foot tendon compared to a bare butt Brazilian wax from Olga? The doctor cheerily ushered me out and said I would be golden, as good as one of Tyler the Creator’s sunflowers. So I limped to dad’s car exhausted and stunned, not knowing what the follow up treatment was or how long my foot would be wrapped up in the temporary bandage.

Looking back now, I was totally blindsided and crushed in the moment. I’m Mackenzie Patel, the girl who doesn’t need coffee in the morning because I wake up energized and excited; ten million projects are on my plate and I love devouring them all. To have this obstacle - a tangible, physical break in my delicate bone - broke my spirit. I felt like a dejected cripple and utterly useless. My inward thoughts started mirroring my external wounds, and I slipped into an undiagnosed but probable depression - I was sad about my foot and sick to my stomach when thinking about Nikhil and I’s future. What are you supposed to do when you know your dad won’t come to your wedding? How do you process a fractured bone when your mind is already fractured? It wasn’t a lovely garden; I was more like a place where peasants crush the hulls of corn to make cornmeal.

But I rallied and left Florida a few weeks later; I traveled, I loved and I learned oodles about crypto, programming and book writing. My foot was worse - the sole was burgundy red and swollen - but I powered through it. The first time I did yoga after the injection was pure Nirvana; I connected with the energies I thought were missing and relished down dog. My foot was far from healed (the quack made it worse), but I was desperate for normalcy and hated feeling limited. This isn’t a healthy mindset but I rather endure the pain and have physical freedom than sit booted up and restricted. My swelling worsened even after I lessened morning yoga, took shorter walks and quit my other activities completely; I was a slowed-down version of Mackenzie on Xanax and Marijuana.³

I finally saw another podiatrist on March 16, a whole nine days before my 24th birthday and full year since COVID hit. The new doctor examined my foot and shook his head, sighing,

“You’re not supposed to give cortisone injections to a sesamoid fracture.”

He had no answers for my swelling or abject redness but recommended a cute boot⁴ for a month to relieve pressure from the area. So here I am, hobbling to the dock while nursing a Kona Pineapple IPA and wondering how to hell I got here. I’m still recovering - and I might never, since the doctor said old sesamoid fractures rarely heal on their own - but this injury has given me ample time to think, be furious, think some more and shatter loaded dinner plates in between. Here’s what I’ve learned so far:

• It’s laughably easy to slip into a black mood when you’re both physically and mentally broken. However, it’s that same mind - sneaky and fragile but also somehow resilient - that will pull you up from the drain. I always repeat the mantra “I will stay positive. I will stay positive,” because I know it’s essential for my survival right now. I’m normally such a happy, bubbly person and I would hate for my recent experiences to change that. But really, that all depends on how I handle and process these setbacks and hopefully turn them around in my favor.

• Physical health is never something you should take for granted. It’s fleeting and finicky and can seriously impinge on normal life. Just like how COVID swung out of left field, your health is just as fickle so appreciate it when things are going well.

• As my friend Kenton said, “There’s always a solution!” That answer just requires more creativity - since I’m an exercise fiend, I’m watching videos like How to exercise when you’re wearing a boot and buying goggles for swimming, a paddleboard and pull up bar to continue strengthening my body. You’re only as weak as you let yourself be.

• Listen to your body when it speaks up; don’t wait years to address an issue and hope that everything will work out. The US healthcare system is genuinely screwed and most doctors see you as a dollar sign, but it’s still important to play the game for your long-term health. If I hadn’t addressed my foot, I would’ve developed arthritis or compacted the issue more.

I’ll be adding to this medial sesamoid saga as the story develops and hopefully comes to a happy end. Stay tuned and stay limber. 🧘🦶🏽