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Andrea talks Sesamoid Pain!!

Today I want to talk to you about a problem I’m seeing a little bit of lately. It’s called sesamoid pain or sesamoid problems.

Now, you are probably sitting at home asking what the hell is a sesamoid?

Well in your foot you have a couple of little bones that sit underneath the big toe joint called your sesamoids. These little are very important because they help the big toe dorsiflex or bend back and they allow the muscles to glide around the bottom of the toe.

Aside from being very important they can be problematic. Firstly they don’t have a huge amount of blood supply and secondly they’re in a part of a foot that suffers a great of stress and  load.

The reason I want to discuss this is because I’ve had a few ladies who’ve come into the clinic lately with this particular problem. For the majority of these ladies (it generally affects women more than men) had issues because they let it go for a while and unfortunately the longer these issues are left with the sesamoids the worse they get.

Given how important it is to manage a sesamoid early on, I wanted to share just a couple of tips on how to manage and to deal with sesamoid pain to prevent it getting worse. It is also important to know that it’s not going to go away. If you continue the activity you are doing your sesamoid pain is only going to get worse. The longer it goes, the greater the risk of injury. And we’re not talking minor injury here with a sesamoid. Due to their bad blood supply, they can fracture, they can break, and they can even get what we call an avascular necrosis where so much pressure goes through the bone that the blood supply to the area just stops and the bone effectively dies off. Again, you want to really be careful that you’re avoiding that so hence why you want to get onto it early.

Now if you’ve spoken to anybody who’s had sesamoid pain, they’ll tell you how debilitating it can actually be and the impact that it has on their life day to day. One patient springs to mind, a lovely woman, who struggles to chase around after her little boy. And for her that’s really, really hard to take. It’s really, really frustrating for her. And I share that frustration. We’re working really hard to get her back and I’m really comfortable that we’re going to get there and confident that we’re going to win, however we don’t want to get you to that point.

Here are 3 tips to manage sesamoid pain

  1. First thing you need do, avoid any high heeled shoes. Get into a lower drop shoe. Now lower drop doesn’t mean flat. Flat shoes are no good either. The reason high drop shoes (such as heels) are bad is due to the position of  the sesamoids are. Going up into a heel, pushing our foot up into that pointed position, is going to significantly load the ball of the foot and the sesamoids. If you are experiencing sesamoid pain, please get out of heels straight away.
  2. The second thing you need to do is see somebody. I’m deadly serious, you want to see somebody. This is not something that you leave. The problems I suggested earlier are real. I’ve seen the sesamoid effectively obliterate. If it obliterates and disappears, or you have to have surgery, the outcomes are generally not great. So you want to avoid that as much as you possibly can. In my opinion, if you’re having a problem in your sesamoid and it’s been around for longer than a week or two, pick up the phone, jump online, find somebody and go and see them.
  3. The third thing is think about the shoes that you’re wearing even if it is a low drop shoe, in particular the thickness of the mid sole. The mid sole is the part of the shoe that sits between the upper and the sole. A shoe that has a very thin mid sole is not going to offer protection to the sesamoids and especially in the early stages of this particular problem, you want to get into a shoe that has a thicker insole.

When dealing with sesamoid problem can be complicated and without the correct diagnosis and management plan, you really are setting yourself up for a fall. Please see somebody and don’t let sesamoid pain get the better of you because it can be crippling and will prevent you from doing activity for a long time at the least and at worst result in damage requiring surgery and lifetime negative effect.