Good day, good day, bad day, good day, good day

Two adjustments in the last two weeks seem to be changing the severity of my foot pain: I stopped running, and I changed the orthotics I'm wearing.  After Dr. L confirmed my suspicion that the expensive orthotics I bought two years ago were doing me no good, I switched back to a $20 pair that my physical therapist had suggested I buy from Bed, Bath, & Beyond.  They are firmer and provide better arch support.  Sooooo frustrating that wearing the cheaper ones would have been better for my foot all along!  
So lately, the foot pain has subsided significantly. I've taken to characterizing each day as "good foot day" or "bad foot day." This has me wondering if I should even pursue surgery.  Such a huge decision! 
I went back to Dr. L today to find out the results of my MRI.  The gist is that the fractured sesamoid seems to be an old injury, and the main concern is the cartilage loss and beginning of arthritis in my great toe on the right foot. When I told him about the pain subsiding somewhat, he said a few things: 1) It's my foot, and I decide what to live with and how to proceed, 2) It won't get any better, only worse over time, 3) I could be facing a much worse surgery situation a few years down the road because of continuing cartilage loss.
So here's what I decided for today: 

• I went ahead and made 2 appointments, one for casting for a new pair of orthotics next week, and the other for the Tuesday before Thanksgiving, for surgery. That way, I have my preferred date on his schedule, and, as Dr. L said, I can always cancel it if I decide against surgery.  
• I'm going to keep reading an eBook I ordered called The Bunion Survivor's guide to Successful Surgery and Recovery.  
• I'm going to do more investigating into whether Dr. L is the right surgeon for me. 
• And I'm going to keep monitoring my foot's pain level and listening to my inner voice about whether going forward with surgery is the right decision (good advice from a wise friend--thanks, Debi!).  

Here is the official MRI report:


Findings:
There is normal marrow signal maintained within the metatarsals, specifically the head of the second metatarsal displays normal signal intensity.
There is moderate cartilage loss and narrowing involving the first metatarsal phalangeal joint.  There is some minimal bony overgrowth involving the first metatarsal head, as well as the base of the first proximal phalanx.  There is associate joint space narrowing and mild bony overgrowth.  There is perhaps some very minimal subcortical edema involving the articular margin of the first metatarsal head, as well as the base of the proximal first phalanx.  This is however, very subtle.  
There appears to be focal small area of edema involving the tibial sesamoid.  No displaced fracture is evident. There is minimal amount of surrounding fluid at this site.  The contiguous flexor tendon appears intact and normal in signal intensity. 
The intrinsic musculature of the right midfoot displays normal signal intensity.  The dorsal, as well as the planar tendons appear intact and normal in signal intensity.
The distal metatarsals appear intact and normal in signal intensity. The joint spaces appear maintained. 


IMPRESSION:
1. There is a focal area moderate marrow edema involving the tibial sesamoid. This is reportedly at the site of patient's area of pain/trauma. As this edema is nonspecific, could represent bony contusion. However, an underlying subtle occult fracture could also be present. This could be further characterized with thin-section CT for improved bony detail. No definite displaced fracture is evident.
2. There is moderate cartilage loss and narrowing involving the first metatarsal phalangeal joint with minimal subchondral edema and bony overgrowth.
3. The second metatarsal head is normal in signal intensity, as are the remaining metatarsals.