Running with sesamoiditis: How I resolved a 10 year old injury by ditching my traditional running shoes.
I was asked to discuss this topic from a reader and ironically this is the injury that plagued me for 10 years before I finally learned how to run. Sesamoiditis is a condition where the two small bones of the great toe joint become inflamed. This can be the result of what is termed a bipartite sesamoid bone(referring to two bones that have not united into one during develop) or one that has become fractured. A debate exists amongst the literature as to whether a fracture truly occurs to this bone, and if so can it reunite or heal. Symptoms present with sesamoiditis include pain and swelling to the bottom or plantar aspect of the great toe joint. A sharp piercing feeling is sometimes described and one usually will limp or walk with pressure on the outside (lateral) aspect of the foot to avoid pain. The condition can go on for months and sometimes does not respond to rest or padding. It is very common amongst volley players or sports that entail forceful jumping or exploding off of the ball of the foot.
So here’s my story. I was just starting residency and had ran most of my life at that point. I had done 3 marathons and numerous other types of races and really just ran as a means of relaxation. In the year 2000, I developed pain in my right great toe in the region of my sesamoid bones (for those not understanding what they are, i’ll explain shortly). Initially I attributed it to playing ice hockey and my skates were tight and it placed increased pressure to the great toe joint. The problem was, it never resolved. After living with it for about 4 years, it finally cultivated in the winter of 2003 when I was on a run in the wintery snow of Erie, PA and the pain became so severe I could barely run. I had x-rays taken of my foot and found in addition to the bipartite tibial sesamoid knew I had, I now had a fractured fibular sesamoid to go along with it! I wore a boot for 3 weeks, and had to stop running. It never worked. It calmed it down and eventually I was able to run again, but the pain in this region persisted. I had worn holes out to the great to region in the fabric on the insides of my Birkenstock Clogs that I would operate and work in. Was I putting too much pressure here? I just figured I was limping from the pain and the region was wearing. I continued to run. I would have good months, and bad months. Eventually I went on to run several more half marathons, another full marathon, and other road races. My foot still hurt. I would try multiple custom orthotics, OTC semi-custom orthotics, and even various running shoes, but just couldn’t resolve it. I focused on “heel-striking” because that was what at that time I was “told” was the proper way to run. Imagine my frustration. A podiatrist, foot and ankle surgeon, who couldn’t fix his own foot. I had contemplated have the sesamoid removed but I felt that would be too destructive of a procedure because it is encompassed in the flexor hallucis brevis tendon and would create a ton of scarring and fibrosis. Perhaps, Obama care could come to my aid and pay for my treatment; who knows? Not to mention that I was still able to run at times with no pain.
Enter 2009, the year when the questions starting pouring in about barefoot running. I was working an event for the Akron Marathon, when the owner of a local running shoe store (Vertical Runner) walked by wearing a pair of FiveFingers. I needed to put them on. I was getting bombarded with questions about them, and what better way then to have them on my feet to draw more attention to the matter. I wore them for the second half of the day with a suit and tie and fielded questions from the manny runners that walked by my booth. By the end of the evening, I had discovered that I was learning to stand differently because these shoes were killing my great toe! How could they possibly be good to run it? But that was just it. They forced me to stand differently. Had I been standing wrong in my other shoes? Absolutely, but I didn’t know it. I was wearing a pair of dress shoes that day, so of course my feet were going to hurt. But what did the shoe have to do withme standing wrong? I didn’t figure this out for at least another year.
I decided to focus a little more on barefoot running then just wearing a pair of FiveFingers. I started pulling the literature to understand this a little better. Surprisingly there wasn’t much out there on barefoot running. In fact most of it was anecdotal by an underground of runners who most would probably laugh at and never think much of it. But there was something about it. They weren’t getting injured and were running this way for years. That’s when I started pulling more and more literature on traditional cushioned running shoes. Surprisingly, there was not a shred of evidence to support prescribing these for running, foot pain, or any foot ailment that I had been treating and recommending them for. While all of this was happening, I had began transitioning to running in my FiveFingers. I will leave that story for another blog post!
After 8 weeksof transitioning, my sesamoiditis was all but gone! I just presumed it was coincidental as I had good months in the past, but never this long. How could this be? The treatment for sesamoiditis is to cushion the 1st MPJ, use a cut out offloading orthotic, or not run at all and rest it. I was, for all intensive purposes, running barefoot and mine resolved! Fast forward 5 months and I now completed a half marathon in a pair of FiveFingers and my sesamoiditis was 100% painfree.
Was it the shoes? Nope. I learned how to run. After another year or more of reading, learning (world wide collaboration of runners and physicians including Mark Cuccuzzella, Dan Lieberman, and Irene Davis) and now lecturing on this fascinating topic, I had finally got it. It has nothing to do with the shoes. It’s how you run. Yes I had strengthened my feet beyond what they had ever been my whole life, but the form I had now grown accustomed to was what was helping me.
So what does this have to do with fixing my sesamoiditis specifically? I took the pressure off of that area. This happened through a multitude of ways, but one that I think is most crucial is eliminating what most podiatrists and biomechanists used to describe as the “propulsion phase” of the gait cycle. By adapting a midfoot/forefoot strike pattern, with shorter strides,and landing with your foot below your body, the force that gets generated to the MPJ is reduced. You no longer pro-pulse with the great toe joint, but instead you drive forward with your thigh and the foot gets picked off the ground. There is a slight push off occurring with the foot, but its through the entire foot, not just the MPJ. So basically instead of pushing off with only your great toe, the entire foot takes the load minimizing the stress to great toe joint. This reduction in stress and force can allow the flexor hallucis longus and brevis tendons in the great toe joint to heal if they were inflamed which we typically refer to as sesamoiditis. This makes the condition more consistent with a tendonitis then a true boney pathology which can explain why many don’t respond to just simply resting the foot.
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About The Author
Dr. Nick Campitelli
Dr. Campitelli is a podiatrist in Akron, OH specializing in foot and ankle surgery with an interest and enthusiasm for running as well as helping runners with injuries. For the past several years he has been treating running injuries in patients by fixing their form and transitioning them to minimalist shoes. Having treated runners with all types of injuries through conservative measures with orthotics and shoe gear changes to reconstructive foot and ankle surgery, Dr. Campitelli has brought what works best and is most current to his practice as well as the Akron and Cleveland running communities.
Thank you so much! This is an amazing blog post and I have already contacted a running coach to learn how to run properly. Thanks again, you’re awesome!
Hello! This blog post makes me very hopeful!!! I have sesamoiditis and a recent MRI showed that there is a lot of damage to the bone, although the doctor can’t tell if it is fractured or bipartite. ( He said the sesamoid bone on the outside is white or filled with fluid?) I started resting excessively bc the first podiatrist I saw said if I put too much pressure on it then I will damage it more. My present podiatrist has me in a boot for the next two weeks, but I was conflicted because I found that my feet felt the best walking around my house barefoot! However, if I go outside in normal thin soled shoes, the rest of the ball of my foot gets really sore. According to my current podiatrist, this is because it is compensating for the weight that would otherwise be on my first metatarsal. So at the moment, my number one shoes is Sanita(Dansko). Have you had any experience with those? I like them because they make it so that my foot doesn’t have to bend too much, when I’m outside walking around.
A question I have though, is would you say that this style of running you learned to offset the sesamoid is also relevant to how people walk? I hardly ever run, and so for me the issue is mainly while walking.
Thanks so much I appreciate your post a lot!
Dansko clogs can serve as a splint while your recovering. I do not recommend them as an everyday shoe when you recover because you need the flexibility. Also, they have a somewhat high heel which angles your foot and keeps you high off the ground. This makes you unstable. Correct if you don’t run you do have a different walking style. Try to take shorter steps and walk as if you were barefoot. You’ll eventually adapt. Start doing intrinsic muscle strengthening for your feet by using toes more. This will eventually resolve a tendonitis if that’s what your dealing with.
Thank you so much for the reply 🙂
You’re definitely right that the dansko shoes make my foot unstable. My ankle often rolls over, causing me to trip.
Over the past couple of months my foot has become very weak from all the resting! So I definitely think strengthening will be helpful. Especially since i’m flat footed.
One thing that is unclear to me is what you mean about how it is a tendonitis issue? Do you mean that it is the tendon causing the pain? How does the tendon make your bone fracture? And if is NOT a tendon issue, are you doing further injury to the sesamoid bone by learning how to walk barefoot? I know these are a lot of questions, so if you’d rather send me a scientific article or link, it would be much appreciated
I definitely need to do research on pose running/walking, because it does still confuse me about how I would distribute weight on my foot. When I walk barefoot, I feel like I just walk the same.
For the past week I have been in a boot, but I didn’t feel like it was doing anything. So yesterday I walked in my dansko shoes. And then this morning my feet felt really bad. (pain in sesamoid, and general stiffness for entire foot, especially the ball). Way worse than before I even put the boot on.
I’ve been dealing with this for almost a year now so I’m trying to remain hopeful that my foot will be normal again, and that this isn’t permanent and I appreciate all advice. Thank you very much
I really enjoy the way you relate an indepth medical topic to real world application. Thanks again for another great post!
Your welcome! Thanks for reading!!
Our stories sound similar, sort of. I’ve had sesamoid pain in my right foot since I was at least 12 (I’m now 23). It would worsen and heal off and on for 9 year until it got bad enough that I finally decided something wasn’t right. Two years ago I went into the orthopedist and through x-rays found I had bipartite sesamoid bones in both of my feet. The doctor said he didn’t think they were fractured, just bipartite. I was in a foot brace for 4 months, and during that time my sesamoiditis got about 50% better. I couldn’t afford the $400 orthodics at the time that my orthopedist recommended, so instead I bought the $45 superfeet orthodics for metatarsal support. When it felt like the pain had mostly gone away, I started running again.
Around this same time I learned about the barefoot running/vibram shoes and decided to try them even though I was told barefoot was the wrong way to go for sesamoiditis. I’m the kind of person that listens to my doctor’s advice 99.9% of the time, but I had no pain in them so I figured there was something he didn’t know or something magical about the vibrams. In addition to transitioning to the vibrams, I read a lot about running form and technique and made absolutely sure I was running correctly. I didn’t want to go back into the boot for another half a year!
Well, I ran (jog/walked while transitioning) pain-free (in my forefoot) for about 4 weeks when all the sudden my achilles-heel insertion began to hurt. I rested. And rested. And rested some more, but the pain in my achilles (left and right) never subsided. Fast forward to today, I’ve been in physical therapy for my achilles for several months. Things are slowly getting better, but it has taken an entire year for both of these tendons to partially heal (crap I’m getting my heals/heels mixed up!) I also have been wearing very supportive Asics shoes with heel pads (given to me by my physical therapist) AND the superfeet for metatarsal support.
This brings me back to my sesamoiditis. Now, the better my achilles pain gets, the worst my sesamoiditis becomes. If I wear shoes with heel support, it puts more pressure on my forefoot and after a week or so the pain becomes almost unbearable. However, I’m very very very hesitant to switch back to a minimalist style because my achilles pain is not completely gone. Did I transition to quickly to the vibrams at the start? Probably, and I regret it 1000%.
Needless to say, my feet always hurt. They always hurt and I’m tired of it. I’m a fairly physically active person. I don’t run marathons, but I run/walk/jog/hike to melt the stress off. Seeing as how I’m 8 weeks from graduating college, there’s a lot of stress, and reducing my physical activity is torture. I can’t become sedentary at 23. I’m frustrated with everyone: myself, my doctor, my orthopedist, my physical therapist, but mostly myself. I don’t understand why we can drive a car on mars and clone animals but can’t fix foot pain (although I sort of do, as I’m a biology major). It’s just frustrating.
If it was you in this situation, what would you do? Do I go back into my orthopedist and get the orthodics that may or may not help? Do I get a second/third/fourth opinion? Do I chop both my feet off and hope to god they can attach some sweet looking prosthetics?
Seeing as how I’ve had foot pain for the majority of my life, I’ve almost accepted the fact that this is forever. And honestly, that sucks! Thank you for this insightful post!
Oh my god i can relate SO MUCH to what you’ve just said. Which despite everything, makes me really happy. I’m so sorry for everything you are dealing with and I am currently giving you a cyber hug. I am also 23 years old, and I have great frustration over my now sedentary life due to sesamoiditis. My doctor also thinks that it is bipartite instead of a sesamoid fracture, so I’m hoping this is an accurate diagnosis. I recently got an MRI but it is still hard for him to tell for sure. Basically, I’ve had sesamoid pain since last summer, but it wasn’t until January of this year that I realized my feet need serious help. Since then I’ve spent much money on different shoes and insoles and a boot, and doctors appointments, and I feel like with every slight improvement there is another set back. Its like: 2 steps forward 3 steps back, one step forward, one step back, 3 steps forward 2 steps back…you get the idea. Fortunately, I feel like i am making improvement on my right foot, although my left foot is still in a boot. I can definitely relate to your speculative mentioning of getting prosthetic feet. With all my sesamoid pain I’ve been distributing weight to random parts of my feet. So my feet became painful all around and generally achy. Fortunately I don’t have too much heal pain, but I did have achiles tendonitis for two years. It was before I had sesamomiditis, and it was fine as long as I wore shoes with a heal. This is part of the reason why I am hesitant to switch to barefoot, bc I would expect the tendonitis to flare up from it bc I usually get one if i’m in any flat soled shoes. I am currently wearing dansko-esq shoes which although don’t provide a lot of stability for my ankle (they make my ankle role out sometimes), they do limit the movement to my sesamoid, and have a heel/rocker sole so they prob won’t bother your heal. I actually bought a pair of the sanita brand. It took 3 different pairs in different sizes to find the pair that actually fit me. Clearly, the barefoot was working for you, but maybe if you wore these until your heal gets better, it may prevent aggravation to the sesamoid, so it might provide a good balance. I have listed my current treatments below for sesamoiditis, which you’re probably aware of, but if not then check it out. And I’d appreciate any feedback from other people
1. Ice feet for ten minutes, and then soak in warm water (I have raynauds so I soak in warm water to keep up circulation.
2. Contrast baths 2x a day (soak in warm water for 4 minutes and ice water for 1 minute. Do that four times for a total of 20 minutes.
3. Massage arch with a massage ball (I have no idea if this is doing anything)
4. Stretch your legs. Apparently, you’re less likely to do damage to your feet if your legs are more flexible.
5. Rest a lot. Which is so much easier said than done when you simultaneously have to be alive.
6. I’m currently on an anti-imflammatory diet which is very similar to the cave man or paleo diet. And lots of omega 3s. I got a lot of info from this article:
http://www.huffingtonpost.com/dr-robert-a-kornfeld/5-ways-to-reduce-inflamma_b_271640.html
7. Help strengthen the muscles in that area. I have one flat foot so I am trying these exercises.
http://www.ehow.com/how_4550126_rebuild-arches-flat-feet.html
This is really dorky, but I feel like so much of this process is where I am emotionally. And I feel like this foot problem put me in a really dark place (hence dreams of prosthesis which is totally not cool!). And I really believe in holistic health, and if you can have a positive outlook, then you will encourage functions in your body that make you healthy, and that includes healing. I hate the movie The Secret because the movie itself sucks, but I watched it last weekend to atleast use positive imagery and optimism as a means to make myself more hopeful about healing my foot, vs. scan the internet for forums that should offer help, but instead freak me the hell out. Another good book is the happiness hypothesis, and I’d like to read a book on mindfulness, so that everytime my foot hurts I can be mindful instead of freaking out that it will never heal. I’m at the point where I’ve spent so much money on this, that I can’t even afford any more doctor appointments, so I’m expecting the time will be the best cure.
Anyway, let me know if any of this helps and I would love to hear about your progress. Feel free to post your email if you’d like to keep in touch about it that way. 🙂
Eliza – this is almost a year after your comment, but I still felt the impulse to respond. It helped me to read your experience because I too am feeling very emotional and frustrated at dealing with this problem at the age of 30 when I so desperately want to be healthy and active. I’ve also been searching online, only to feel more depressed. I am working on being more centred. grounded, at peace, so that no matter what’s going on, I can still be a healthy functioning person. Good luck!
Marta…I’m not sure if you are still checking this thread, but I really hope so. I would love to know how you’re doing. I have been dealing with sesamoiditis for six months and I have never been so depressed. I’m 37 and I’ve been an athlete for my entire life. Until now. Everything I read is bad news. Nobody seems to recover. If you could tell me how you’re doing, I would be so grateful. I hope you are healed.
Thanks.
Julie
Our stories sound similar, sort of. I’ve had sesamoid pain in my right foot since I was at least 12 (I’m now 23). It would worsen and heal off and on for 9 year until it got bad enough that I finally decided something wasn’t right. Two years ago I went into the orthopedist and through x-rays found I had bipartite sesamoid bones in both of my feet. The doctor said he didn’t think they were fractured, just bipartite. I was in a foot brace for 4 months, and during that time my sesamoiditis got about 50% better. I couldn’t afford the $400 orthodics at the time that my orthopedist recommended, so instead I bought the $45 superfeet orthodics for metatarsal support. When it felt like the pain had mostly gone away, I started running again.
Around this same time I learned about the barefoot running/vibram shoes and decided to try them even though I was told barefoot was the wrong way to go for sesamoiditis. I’m the kind of person that listens to my doctor’s advice 99.9% of the time, but I had no pain in them so I figured there was something he didn’t know or something magical about the vibrams. In addition to transitioning to the vibrams, I read a lot about running form and technique and made absolutely sure I was running correctly. I didn’t want to go back into the boot for another half a year!
Well, I ran (jog/walked while transitioning) pain-free (in my forefoot) for about 4 weeks when all the sudden my achilles-heel insertion began to hurt. I rested. And rested. And rested some more, but the pain in my achilles (left and right) never subsided. Fast forward to today, I’ve been in physical therapy for my achilles for several months. Things are slowly getting better, but it has taken an entire year for both of these tendons to partially heal (crap I’m getting my heals/heels mixed up!) I also have been wearing very supportive Asics shoes with heel pads (given to me by my physical therapist) AND the superfeet for metatarsal support.
This brings me back to my sesamoiditis. Now, the better my achilles pain gets, the worst my sesamoiditis becomes. If I wear shoes with heel support, it puts more pressure on my forefoot and after a week or so the pain becomes almost unbearable. However, I’m very very very hesitant to switch back to a minimalist style because my achilles pain is not completely gone. Did I transition to quickly to the vibrams at the start? Probably, and I regret it 1000%.
Needless to say, my feet always hurt. They always hurt and I’m tired of it. I’m a fairly physically active person. I don’t run marathons, but I run/walk/jog/hike to melt the stress off. Seeing as how I’m 8 weeks from graduating college, there’s a lot of stress, and reducing my physical activity is torture. I can’t become sedentary at 23. I’m frustrated with everyone: myself, my doctor, my orthopedist, my physical therapist, but mostly myself. I don’t understand why we can drive a car on mars and clone animals but can’t fix foot pain (although I sort of do, as I’m a biology major). It’s just frustrating.
If it was you in this situation, what would you do? Do I go back into my orthopedist and get the orthodics that may or may not help? Do I get a second/third/fourth opinion? Do I chop both my feet off and hope to god they can attach some sweet looking prosthetics?
Seeing as how I’ve had foot pain for the majority of my life, I’ve almost accepted the fact that this is forever. And honestly, that sucks! Thank you for this insightful post!
Our stories sound similar, sort of. I’ve had sesamoid pain in my right foot since I was at least 12 (I’m now 23). It would worsen and heal off and on for 9 year until it got bad enough that I finally decided something wasn’t right. Two years ago I went into the orthopedist and through x-rays found I had bipartite sesamoid bones in both of my feet. The doctor said he didn’t think they were fractured, just bipartite. I was in a foot brace for 4 months, and during that time my sesamoiditis got about 50% better. I couldn’t afford the $400 orthodics at the time that my orthopedist recommended, so instead I bought the $45 superfeet orthodics for metatarsal support. When it felt like the pain had mostly gone away, I started running again.
Around this same time I learned about the barefoot running/vibram shoes and decided to try them even though I was told barefoot was the wrong way to go for sesamoiditis. I’m the kind of person that listens to my doctor’s advice 99.9% of the time, but I had no pain in them so I figured there was something he didn’t know or something magical about the vibrams. In addition to transitioning to the vibrams, I read a lot about running form and technique and made absolutely sure I was running correctly. I didn’t want to go back into the boot for another half a year!
Well, I ran (jog/walked while transitioning) pain-free (in my forefoot) for about 4 weeks when all the sudden my achilles-heel insertion began to hurt. I rested. And rested. And rested some more, but the pain in my achilles (left and right) never subsided. Fast forward to today, I’ve been in physical therapy for my achilles for several months. Things are slowly getting better, but it has taken an entire year for both of these tendons to partially heal (crap I’m getting my heals/heels mixed up!) I also have been wearing very supportive Asics shoes with heel pads (given to me by my physical therapist) AND the superfeet for metatarsal support.
This brings me back to my sesamoiditis. Now, the better my achilles pain gets, the worst my sesamoiditis becomes. If I wear shoes with heel support, it puts more pressure on my forefoot and after a week or so the pain becomes almost unbearable. However, I’m very very very hesitant to switch back to a minimalist style because my achilles pain is not completely gone. Did I transition to quickly to the vibrams at the start? Probably, and I regret it 1000%.
Needless to say, my feet always hurt. They always hurt and I’m tired of it. I’m a fairly physically active person. I don’t run marathons, but I run/walk/jog/hike to melt the stress off. Seeing as how I’m 8 weeks from graduating college, there’s a lot of stress, and reducing my physical activity is torture. I can’t become sedentary at 23. I’m frustrated with everyone: myself, my doctor, my orthopedist, my physical therapist, but mostly myself. I don’t understand why we can drive a car on mars and clone animals but can’t fix foot pain (although I sort of do, as I’m a biology major). It’s just frustrating.
If it was you in this situation, what would you do? Do I go back into my orthopedist and get the orthodics that may or may not help? Do I get a second/third/fourth opinion? Do I chop both my feet off and hope to god they can attach some sweet looking prosthetics?
Seeing as how I’ve had foot pain for the majority of my life, I’ve almost accepted the fact that this is forever. And honestly, that sucks! Thank you for this insightful post!
Thanks for your long comment! I feel your pain. Obviously I cannot diagnose or treat you through email but I will give some comments. Again this is not meant to be in place of you seeing a physician.
Sounds to me like your transition was too fast. Your Achilles will definitely take more stress as you learn to run this way. In fact, recent studies demonstrate a marked reduction in force to the knee with forefoot/ midfoot strike patterns which is transferred to the Achilles. But remember, the Achilles and gastrocsoleuos muscles can adapt to this stress over time and handle the force. The knee. (Or any joint) cannot. And, it’s not the FiveFingers doing anything directly. They just allow you to run naturally. Traditional running shoes prevent you from running with natural form. (My text explains this in simplistic terms if you haven’t seen it yet)
Again, I really can’t give you advice, but what I can tell you (and what I tell a lot of runners suffering from chronic injuries) is to reset your running and walking and standing. Meaning get into flat, flexible, light shoes that allow your feet to function the way they were designed. This can’t happen over night as it takes the body time to recover from it’s existing injury as well as adapt to its new way of functioning. It is recommended to wear this type of shoe gear an hour a day, gradually increasing an hour each week for 6-8 weeks at which one should be closed to being able to wear daily. It also helps going barefoot at home on the same manner through gradual increments.
Orthotics on this, and 95% of the time, can only work for temporary improvement. For orthotics should never be meant to be used indefinitely. They are a cast for your foot.
Hope this helps!!
Dr. Nick
hi dr nick,
your paragraph on walking helped me ALOT: pushing thru using the thigh, landing on mid/forefoot etc.. i’m having trouble standing though (i’m in the process of rebuilding myself after almost being in a wheelchair jan 2013).
what is your advice on standing? so far what i’ve done is 1. keep 3 points (triangle) on the foot in mind: under the big toe, under the pinkie toe, the heel 2. slight bend of the knees 3. focus effort on quads/hamstring/pelvis/lower back area. anything to delete/add?
you and dr ray mcclanahan are amazing for being the exception to the rule when it comes to podiatrists. thank you so much!
-cliff (san diego)
Thank you for the kind words!
As for standing, the less between your foot and the ground the better in regards to improving your proprioception- ability to feel the ground and send signal to brain which then sends it back to have feet adapt to ground.
The tripod description is correct, although I wouldn’t focus on obtaining it. Your foot should naturally obtain that position if your dispersing your weight appropriately.
Of course I can’t give medical advice, but I hope the helps!
hi dr nick,
your paragraph on walking helped me ALOT: pushing thru using the thigh, landing on mid/forefoot etc.. i’m having trouble standing though (i’m in the process of rebuilding myself after almost being in a wheelchair jan 2013).
what is your advice on standing? so far what i’ve done is 1. keep 3 points (triangle) on the foot in mind: under the big toe, under the pinkie toe, the heel 2. slight bend of the knees 3. focus effort on quads/hamstring/pelvis/lower back area. anything to delete/add?
you and dr ray mcclanahan are amazing for being the exception to the rule when it comes to podiatrists. thank you so much!
-cliff (san diego)
hi dr nick,
your paragraph on walking helped me ALOT: pushing thru using the thigh, landing on mid/forefoot etc.. i’m having trouble standing though (i’m in the process of rebuilding myself after almost being in a wheelchair jan 2013).
what is your advice on standing? so far what i’ve done is 1. keep 3 points (triangle) on the foot in mind: under the big toe, under the pinkie toe, the heel 2. slight bend of the knees 3. focus effort on quads/hamstring/pelvis/lower back area. anything to delete/add?
you and dr ray mcclanahan are amazing for being the exception to the rule when it comes to podiatrists. thank you so much!
-cliff (san diego)
Thank you for the kind words!
As for standing, the less between your foot and the ground the better in regards to improving your proprioception- ability to feel the ground and send signal to brain which then sends it back to have feet adapt to ground.
The tripod description is correct, although I wouldn’t focus on obtaining it. Your foot should naturally obtain that position if your dispersing your weight appropriately.
Of course I can’t give medical advice, but I hope the helps!
Hello.
I’ve been struggling with sesamoid pain in my right foot for about 1.5 years now. I first had the problem in October of 2011 at the end of my cross country season sophomore year college. I was told I had a bipartite sesamoid as well as a stress fracture in the medial bone. I wore a boot for 8 weeks, got orthotics made (350 bucks!!) aqua jogged a lot after that, started doing spin class, then elliptical, and then finally that August I tried to run again. The pain wasn’t completely gone but it was around a 3 so I wanted to see how running would be. I started with 1 minute a day then 2…ect. It didn’t go very well…by the time I got up to 10 minutes I had extreme pain so I decided it wasn’t time. Then in December of 2012 I decided to try to run again as I had no pain in my sesamoid anymore. I was able to make it to 20 minutes this time without pain but right at 20 minutes I would have a lot of pain. My athletic trainer at school told me to try to keep running as my sesamoid bone needed to get used to this kind of force again. So I did…I iced after, did contrast baths throughout the week, and only ran 2-3 times a week 20 minutes. Eventually I made it up to 30 minutes but it ended there. I still had pain around a 3-4 at the end of runs and eventually ended up getting hip bursitis due to poor biomechanics.This has been such a frustrating experience and I really miss running…(i used to be able to do 45 miles a week). I’m still able to spin, elliptical, swim, ect without any pain. But i’m only 21 and i want to be able to do 1/2 marathons, 10ks, and 5ks with friends. I don’t understand why it’s just running that bothers it! But anyway, I’ve been wanting to try Altra Zero drop shoes but I’m very nervous it will make things worse. I have very high arches and tight calves…so do you think would it better to wear shoes but adopt a forefoot strike and increase my step rate instead?
Sorry for just a long comment but I wanted to give you the whole history!
Wow, I really want to thank you for writing this article. I stumbled upon it by accident, and am ever so thankful I did. I am
An avid runner and biker and I have been struggling to heal my sesamoditist injury to no avail. I been staying off it as much as possible an icing it and i have been using kenesio tape as well. I literally teared up when I read this, there is hope! (It’s been one of the more frustrating athletic injuries I’ve experienced so far). One question though, there are soooo many types of five finger toe shoes out there, and barefoot shoes , I have no idea where to start, especially when looking for one that might help my injury. Would you please recommend a few brands/ companies to me???!
Thanks so much!
Michelle.
New Balance Minimus, Altra, and Skechers. Look at my shoe reviews section.
Hi Dr Nick,
I too have been frustrated with suffering from sesamoiditis. I have not been training for over four months (and being a netballer, touch player and runner this is killing me). Whilst resting has pretty much eradicated my pain I still feel twinges and feel like the injury has not cleared up and will flare the minute I try and get back to it.
I have decided to try and fix my style of running and walking in case this is the problem. I am making an effort to try and go shoeless whilst at home etc. I wondered if there is a site/book u can recommend on running technique. Don’t want to get this wrong and cause other problems.
Thanks,
Erin
hey! come check out my website http://samco.gps5.com/ we have great deals on a variety of running supplies and equipment. thanks!
Thank you for this very helpful article. I stopped running for about a year, and when I came back to running using my new minimus shoe, my right foot was sore. Again, thank you!
I have had flat feet for my whole life, my feet have always hurt and as a child I came to believe everyone’s feet hurt. My ankles would hurt so much at times I would cry. My mother has flat feet from a stress injury, but somehow never noticed my problem. My ankles do not line up with my feet(lean inwards) and I can only assume that is why they hurt (probably to much pressure). My arches hurt, my heel hurts….my entire foot hurts. I never participated in any sports other than riding horses because just gym class was excruciating. We would be asked to run and within minutes my back would hurt so bad I’d end up walking(my teacher hated me).
Now as a 23 year old I realize that unlike what I have believed my whole life, most people can walk, stand or run, without extreme pain.
About a month ago I started experiencing a new pain….my right big toe joint feels like a horse stepped on it….and none did. I find myself walking barefoot whenever I can(it has always been the most pain free way to get around), and I can’t keep my shoes on at work. I’ve become used to back, knee, ankle, and my normal foot pains. Sounding like an 80 year old woman getting up with my knees cracking is normal for me….limping at work is not. I have a high pain tolerance. I have broken bones before and it does not hurt this much. I played basketball in gym with a broken finger and it was not only because my gym teacher was the worst teacher ever and didn’t believe I hurt myself.
Do you have any advice? I already wear the cheap Walmart arch supports, although they have to be replaced a lot because they wear out and start feeling like nothing. I slouch to relieve constant back pain, yes I know it’s bad to slouch, but it makes my back feel better. I ruin trips to amusement parks and the mall because my feet hurt so bad I can’t walk. I’m tired of being in pain. I want to be able to walk without pain.
Hi. Thanks for the information. I fractured my sesamoid running. I continued to run several races without letting it heal. Any heck, it is now 4-5 years later. I run in Nike Vomero sneakers and have orthotics. The initial pain has lessened over the years- seems to throb/heat up at mile 13-16 but I can run through it. However, I always seem to have what I imagine is chronic tendonitis in the same foot, inner arch. I have been hesitant to try minimal sneakers as it seems contrary to the “offloading” concept. Should I really give it a try?
ps. I have high arches
I have had bipartate sesamoiditis for 1.5 years now in both my feet , w high arches. I’ve rested, stopped running (have always ran / soccer player), stopped wearing heels, worn the boot, and tried orthodics. The pain sometimes becomes tolerable and with one wrong step can inflame all over again. I am told a variety of contradicting advice, from : resting / staying active, wearing shoes at all times (even in shower) / don’t wear shoes at all, ice / don’t ice, stretch / don’t irritate the muscles by stretching. I am at a loss at this point (and like many others are young and fearful of inactivity for the rest of my life) , so my questions are:
1) Do you recommend a cortisone shot to reduce the initial inflammation ?
2) What types of (flat and flexible) every-day shoes would you recommend ?
Thanks so much for your time with us all , it is much appreciated.
-Chelsea
Dr. Nick,
I saw in another post that you chose to get a Cortisone injection for your plantar fasciitis. Would you ever consider that treatment for sesamoiditis? Are there any concerns with that treatment? I’ve been told they can affect tendon strength–and that seems like a concern in the feet.
Thanks!
Do you think the product “Correct Toes” by Dr. Ray McClanahan will help aleve my sesmoiditis? I’ve researched it and it seems to agree with what you promote about form and splaying the feet.
Do you think the product “Correct Toes” by Dr. Ray McClanahan will help aleve my sesmoiditis?
I’ve read about it and seems to agree with the form issue you promote about strengthening the whole foot.
I”ve tried everything else, it’s been a year.
Kristen
Dr. Nick…my son whom I am writing about is also named Nick btw…he is a 15 year old competitive HS athlete. Whose primary sport is football as a freshman he got called to play for varsity as a defensive back and running and has greatly enjoyed this sport since age 8. During the winter he runs track and the spring he plays lax. During the winter track season he fractured his sesamoid in Dec 2013. Nick’s form when running long distance, is exactly like his “football form” since he is a running back everything is based on running on the balls of his feet for sharp cuts and burst speed.
In result his podiatrist treated this by placing him in an air cast for 1 month. During this time there was slight improvement. Nick saw his podiatrist during mid Feb 2014, and the air cast was removed, during this time he still suffered from pain to the extent that he did not complete the winter track season and remained inactive. A follow up was done in March this time for orthotics. The podiatrist stated that he could begin running. The pain was such that he could not run more than a1/4 mile without pain. Please keep in mind this is a young man who has had injuries in the past, but nothing that has kept him off the field for more than 2 weeks.
The orthotics arrived in April 2014 again minimal result were gained. Nick did not play lax or run track in the spring, again trying to keep focused to prepare for the football season which begins in July with summer workouts.
My wife and I decided to see the orthopedist who evaluated him in June just prior to fathers day, (I was hoping he would say that the bone was healed and that Nick was feeling some pain from being in active), but my doubts came true and after talking a new set of xrays he determined that there was a non union fracture, so in result Nick is on a bone stimulation machine….im hoping this works. Its just very difficult for him not to be doing anything to the extent he is forgoing being with his friends on a nice summer day because he doesn’t want to walk on his foot to injure it.
I understand that he has to adjust his running form for long distance with more a distribution throughout the foot,. however im not sure how this would translate into “football running” I just want to prevent any surgery Dr. Nick. Is my son on the right track to recovery, should we be doing anything different i.e seeking the input of a sports podiatrist/orthopedist. We are from Boston and I do realize we are in one of the greatest medical communities in the world. Any additional advice would be greatly appreciated. Thank you again!
Thanks for reading and reaching out. I will do my best to give my thoughts on this condition but I can’t give advice on the internet. Sesamoiditis and fractured sesamoids is a very controversial topic. It is sometimes speculative as to whether or not these are truly fractures or inflammatory. I too have treated sesamoids as a fracture with bone stimulators and can not sat that the situation was truly from a fracture. In my experience if the symptoms do not respond after 6-8 weeks of conservative therapy I do I not consider it a fracture. Of course it depends on the length of time initial symptoms have been present as well. At this point I advise corticosteroid injection and immobilize again in a walking boot for two weeks. I must did this for a track athlete in the spring who had recovered successfully. He had been plagued for weeks in the winter after wresting with it and we were successful with one injection and he was able to run track painfree. The concern is do you inject a fracture? In the case of sesamoids is this truly a fracture? I can not honestly that that I have encountered many unions of sesamoid fractures, if any at all, which leads to me side with the group that terms this an inflammatory situation. If you inject and it doesn’t improve you really are in the same position. Could it prolong healing if it is a fracture. Didactically speaking that’s the concern but with this situation I have seen it help more often not. I would look at this as you tried treating as a fracture and the symptoms are not resolving. I would try a cortisone injection at this point followed by 2 weeks of no running and walking only in a walking boot. As for activity following that. You just need to begin gradually and gradually increase the miles.
Good luck and let me know if you have any questions.
Dr. Campitelli recommends consulting a physician prior to starting any exercise program and the information provided here is not recommended to be advice in place of seeing your doctor for a medical problem.
Dr. Nick thank you again for you reply. I will take your advice with regards to the walking boot, which my son has been in since school has ended during the last week in June. There are approximately 2.5 weeks left regarding bone stim treatments ending on July 17th. At that time we are following up with the orthopedist. Take care.
Hi Dom – we are in the Boston area and realize this post is more than 2 years old. Wondering if you found someone in the area that you were successful with. Our daughter is 12 and is dealing with similar issue. We are just starting the journey but I don’t love anything I am reading. Hopefully you have a success story ?!?!
Hi Naomi,
Just wondering if your daughter’s sesamoid injury healed. We are also in the Boston area and our 13 year old was diagnosed with a non -union of the sesamoid bone. Would love to hear your experience. Our son has been in a boot for 2 weeks and using a bone stimulator. Thanks for any insight/advice.
Hi – We had a lot of success with the dancer’s pads. I believe our daughter’s was more sesamoiditis developed from an acute injury during a soccer game. Good luck!
My daughters (18 yrs) foot got sore after been on the threadmill for few minutes (on 31st march 2014) following day foot (big toe are very sore,) had xray 2 weeks later , told all was ok, foot sore for mionths had physio few times, helped a little and she could put her foot on the ground without pain for first time in months, but this only lasted few hours…returned to g.p and sent to m.r.i and showd that she appears to have sesamoiditis and a fibular sesamoid strees fracture. there is (17 weeks later) swelling around the toe and the ball of the foot,She has very severe allergies and cant take normal antiinflamotories,(getiing homeopathic treatement) she has seen an orthopedic surgeon twice but he has been unhelpfull..Her foot remains very sore and she cant walk without pain and is still using cruches. From reading internet most injuries heal in 6/8 weeks but jessicas is 17 weeks yesterday…….Has anyone any ides?
Hi there,
I came across your post from endlessly searching if I have Gout or Sesamoiditits or something worse.
3 years ago I stubbed my big toe, perhaps an inch down from the metataraal head on the inner edge of my foot. I never did get an xray and was told it was a severe bone bruisw by my doc.
I went to my podiatrist about a year and half later due to pain I kept getting and inflammation making it look like a bunion when it flared up – she assures me I do not have bunions just wide feet due to collapsed arches. So I have evee since been wearing an Orthotic for my arches but also to “reduce pressure” of my big toe or something.
the thing is I am only 23 yeara old and I am STILL getting flare ups with the pain and inflammation. The pain is mainly felt when my big toe is in a bent position and mostlt on the outer edge of the head and a bit behind it. These flare ups happen if I increase my activity and mileage. It is so frustrating because I don’t actuallt know what it is.
I am going to my docs next week to ask for an MRI to get to the bottom of it. I just really hope its not a fracture of a sesamoid bone 🙁
I have been diagnosed with sesamoiditis about a year ago. I am a United States Marine so fitness is of the utmost importance. I tried the minimalist shoes such as the five fingers, and it did actually hurt the top of my foot. My sesamoiditis came about three years after it. It is on my left foot. I have always struck heavier on my left side than my right side. I am curious to which type or model of five fingers you would suggest. I don’t want surgery. Please let me know what you think.
GySgt Plants
It can take a long time to change your gait and get this to calm down. It’s not the shoes directly that will fix it, it’s the gait changes and strengthening of the foot that will be the cure. Try doing these exercises http://www.drnicksrunningblog.com/improve-your-plantar-fasciitis-with-strengthening-exercises-not-orthotics-or-shoes/ . Also you may want to try the Altra Running shoes. They are a zero drop shoe with a little bit of cushion. Thanks!
Do you have any suggestions for my 14 year old daughter who plays volleyball? She was in a boot last year recovering from sesamoiditis – she has VERY high arches and now that club volleyball is starting (& it’s paid for) – she’s having flare ups again. I’ve ordered sesamoid pads to redistribute weight but they don’t stay in place in her vball shoes. I’m at my wits end. Still paying for expensive orthotics another podiatrist made for her – which seem to aggravate the issue & only support her arches. Would gladly see a doctor who can give us some practical help (we live in Medina). She did good in the fall w/school season using reasonable padding (ran out of what the last doctor gave us) & doing needed stretches consistently (occasional ice & ibuprofen). Please help.
It’s very hard to fix if you don’t remove the source. In this case it’s probably her propulsing off of the great toe joint. I see it frequently with volleyball players and even people doing the P90x exercise videos because of the forced dorsiflexion of the toe. You can pad it all you want, but the force of the joint typically leads to the pain. It needs to calm down, and then strengthen the foot with barefoot strengthening activities. An injection may help. In my experience I’ve never seen orthotics fix it. I’d take them out. I’d be glad to see her and give my opinion. Thanks for reading!!
Thanks Dr Nick. I would definitely be interested in having you see her if you can help her get through this season and then work on a longer term fix after it ends. Should I call your office on Tuesday?
Yes. You can call 330-864-8501. We should be able to get her in within a week. Thank you
Hi Dr. Nick
Thanks a lot for this post.
I read this article 10 months ago, months after I found out I had seamoiditis on my left foot, and after giving up on orthotics (worked great for a month and then pain came back again).
At that time, I could barely walk the three blocks that separate home from work, and could only run for 2 blocks -with prescribed insoles- without pain.
Without hesitating I decided to start running in minimalist shoes. This took incredible patience an frustration but I was able to be constant. Mainly, because from the first day of running I felt no sesamoid related pain while running.
Last sunday I run my first 10K / 6.2 Mile race running in minimalist shoes and even achieved a personal record.
While my sesamiditis is not completely gone, since I have to wear dress shoes every day, it’s been great to know that I can keep running!
Thanks a lot!
Dr. Nick
Did you eventually take more X-rays of your sesamoids? Did they ever heal, or did your pain just go away but they are still fractured? I have a tripartite R tibial sesamoid fracture that has kept me from running and playing soccer. I used to run about 3 miles a day and do half marathons, but have stopped since I got the diagnosis and that was 1 year ago, but my toe had been hurting for about 3 years prior to that. I am a physical therapist and need to be on my feet all day, I dot my exercises and have adopted yoga almost daily. I know my problem probably raised from tight hamstrings and grastrocs which increased the extension of my great toe. I wear danskos for work, but am thinking maybe this is not the best idea based on your post, but it’s the only thing that helps me get through the day. I also tape my toe and use orthotics when wearing other shoes which helps the pain. But I was always surprised that it didn’t really hurt when I walked barefoot. I would have never thought the the barefoot running thing would be a good idea, because I always thought I would need firm soled shoes. But I am thinking of giving it a try. I am also thinking of getting a bone stimulator because I read a case-study that helped heal a dancers chronic sesamoid fracture. Any thoughts on bone stimulators?
My sesamoids are still fragmented on radiographs but may have formed partial unions as it is very hard to tell. They are also encapsulated in the flexor hallucis braves tendons plantar to the joint. I would work on strengthening exercises for your foot as well as transitioning out of the Dansko’s. They may feel better, but honestly, they are so bad for your feet and even more importantly your legs, and back. You could try a bone stimulator as it would not hurt. My plan for these types of situations are rest until the pain improves that start strengthening the foot. You will need a flat shoe. Don’t focus on arch support. Cushion is ok, but you really don’t need a whole lot. Your feet will adapt over time but it’s going to take 8-12 weeks to see improvement- as with any rehab or strengthening program.
Hi All,
Here to share my story – maybe it will help a few. I am 23 and fractured my sesamoid bone when I was 20 (playing basketball – landing from a jump). I spent 2 months in denial, until I could barely walk, went to an orthopedist and was diagnosed with a sesamoid fracture.
My orthopedist recommended putting me in a boot for 4-6 weeks. However, not wanting to take any chances, I put myself on crutches for 5 weeks. The ball of my foot never, ever touched the ground for those 5 weeks. While this may have kept the healing process from being interrupted, the muscle atrophy and loss of flexibility was a hefty cost. I also understand that bones need load to remodel, so was my approach the best? I’m not sure, but it worked (more about that later).
During the 5 weeks of crutching, I also taped my toe ( “turf toe” tape job). My toe stayed in a neutral position due to this taping. Even though I wasn’t walking, I didn’t even want to risk stressing it any way.
Other things I did — I began taking calcium (with Vitamin D) supplements. I made sure I got 100% RDA everyday. I iced at least once a day. When I slept, I wore a “bunion splint, because I didn’t want my big toe bending when I was asleep.
(Last two little tips, I promise!) Whenever your feet get “cold”, blood flow is reduced. With this in mind, I always made sure my feet were not cold. I wore warm socks. This may be the weirdest advice I’ll share, but whenever I would feel random tingling/numbing/burning in my sesamoid, I would just rub the arch and ball of my foot until it stopped. I don’t know if this did anything healing-wise, but it always made my foot feel better and usually those sensations would stop.
Following those 5 weeks, my focus shifted to regain strength slowly. I got into a walking boot and used one crutch for a week. Then, I transitioned to no crutch, boot walking for a weeks. Again, the goal of doing all of this was to rebuild strength in a safe, controlled manner.
An x-ray was taken again (this is 7 weeks post-diagnosis) and the seasmoid bone showed no union, but it did FEEL a lot better. I tranisitoned to walking in very supportive shoes (ASICS cross training shoes) and custom “sport” soft orthotics with a metatarsal pad.
I literally did nothing but walk and do spin classes (moderate intensity) for a month. Following that, I shifted my focus to activities that would be more intense but “safe”. I began taking Group Power classes (same thing as Body Pump) and built my strength back up in my legs. Lunges definitely were uncomfortable at first but slowly they began to feel “normal”.
I also began to take step aerobics, which was a little risky, but I just went by my own rule “if it doesn’t hurt while doing the activity, and 3 days after, I can proceed and slowly build intensity” Again, this was all in highly supportive shoes with custom orthotics.
I began to do more research on forces on bones. I remember reading that more force will be applied to the metatarsals and sesamoids if the intrinsic foot musculature is weak. With this in mind, I kicked my orthotics and highly supportive shoes to the curb (except when doing my moderate impact exercise activities) and began walking in Nike free run+3 (the 5.0s). I began walking in them 5min a day and gradually increased to the poitn where I would walk to my college classes in them (3 miles a day). My foot began to get stronger, and I could also see changes physically. I also started walkin barefoot around my apartment (something I was advised to never do again)
Not to bore anyone to death, but I kept this “safe” approach for years. After 1 year, I remember trying to run on a treadmill, and play basketball, and really hurt the next day after these activities. So I backed off those activities. Another year (I know, it’s hard to hear “year”) passed and I was feeling better. Basketball didn’t hurt and I could run on the treadmill with no pain (in Nike Frees too!). I decided to get my sesamoid bone x-rayed and it had healed. I’m assuming the union happened around 1 year and 8 months, that is when I really started feeling better.
While Basketball and treadmill running, and pretty much every other activity (high intensity spin class, HIIT classes, high impact activities) — running outside still gave me pain (despite healed sesamoid).
I began going to a physical therapist who noticed a fair amount of stiffness in the metarsals and limited ankle mobility. We corrected these issues and I began being able to run outside.
Today, I ran 3 miles outside (on concrete) in Nike Free Run 3.0s. Sure, 3 years is a while, but sesamoid fractures are a beast that you really shouldn’t mess with. There is no “quick fix”, you have to listen to your body and go by how it feels, and you have to fully rehab (get all range of motion in ankle back, rid stiffness from foot – i.e. no crepitus) before running outside again. Take baby steps! I promise, you will be so grateful you did.
Hope this helps!
Hi TW,
I’m not sure if you are still checking your posts. If you are, I would be SO grateful to chat with you. I am so despondent and discouraged after six months with sesamoiditis (my story sounds like yours). I don’t know what to do. I have seen everyone, done every treatment, paid thousands of dollars. I would love to know how you are doing, and even though you don’t know me, if there is any way you’d be willing to talk to me (either via email or phone), I would be so grateful. I’ve learned reading these kinds of blogs that injured athletes are very understanding and empathetic. I appreciate you taking the time to provide so much detail in your post. I hope we can talk.
Thank you so much.
Julie
Dr Nick,
This has been an interesting post. I know much time has passed but it makes me a little hopeful that recovery is possible. 6 years ago I was training for my first half marathon and the pain was so bad I had to drop out. Diagnosed with sedamoiditis and given hard 3/4 custom orthotics to wear. Years go by and I never run again as the pain is still there. Last year I finally decided to do something about it because I could no longer walk barefoot. Did one cortisone shot and it got better for a little bit. Tried anti-inflammatory meds also. MRI shows no fracture, but shows burtisitis and mild bunion. Dr convinced me the bunion (and flat feet) is causing my sesamoid problems so we do Austin bunionectomy 7/14. Ever since I now have joint pain from the surgery plus sesamoid pain. It’s really frustrating. I have spent $550 on custom orthotics for my athletic shoes so I can at least do some elliptical and weights, but I cannot walk barefoot. Even had the one screw removed. I am considering another shot from the bottom of my foot under anesthesia. Curious as to whether you have treated it this way?
And for others reading I don’t recommend bunion surgery for a bunion that doesn’t bother you!
Hi there,
I came across your post and it’s given me a bit of hope. I am not a runner but was incredibly active in several high impact sports, and lots of hiking/walking. I broke my sesmoid bone at the end of January in my left foot, and was essentially sent home with some Ibuprofen from emerg. My family doctor had been away so when I saw her two weeks later she told me I should be in an Aircast so it was at least three weeks after the break before I got it. It’s been five months now, and I am seeing a sports doctor but have had limited options given to me so I’ve been Googling and finally have realized how long this can last and trying to find alternatives to surgery, which they won’t consider for at least another six months anyway. I stopeed with the Aircast because it was causing more harm than good after 6 weeks, and I am going to physio. They have helped with mobility, muscles, etc and want to try taping the arch. This has at least helped with the “staying active” side of things so I can walk the dog, and do as much weight exercise as I can to keep strength and mobility while healing. Since I weight bear now on the side of my foot rather than the balls because of pain, we’re working on changing the weight placement of my foot, and keeping the muscles mobile. I also have orthotics being made by someone who has suffered from, and specializes in, sesamoidistis which I have now developed in my compensating right foot. I use heat and ice every night and rest as I can, but in the real world, my sitting and resting time is limited to when swelling gets bad, or at the end of the day. Surgeons have told me to just push to remove it (the bone that is broken at least), recover and move on. I worry that it may cause long term issues so I aiming to allow it to heal on it’s own. I feel like I am doing everything I can do, but thought I’d ask your opinion.
Absolutely any advice is welcome. Do you know of sesamoid breaks that have eventually healed?
Thanks,
Allison
My son is a distance runner who injured his sesamoid running HS indoor track 9 months ago. MRI shows bipartite and white (low blood flow). He is now in college but still feels it and favors that foot which messed up his mechanics. Have you ever tried ESWT? or ultrasound therapy?
He is considering taking the minimalist route but very confused and frustrated. Will this change in gait slow him down in competitive running?
ESWT is an option but scientific literature is not conclusive. Ultrasound can always have an effect but you need to find the source of the issue. If he is heel striking and then toeing off this can really increase the force to the great total joint. Changing the gait to land with more of a midfoot strike would decrease the force that’s going through the great toe joint. You can try a cortisone injection if that hasn’t been attempted as well. But remember. Have to fix the problem.
Chagrin gait won’t slow him down. Speed is innate and genetic and can be tweaked and improved. Is he slows down and fixes his foot he’ll ultimately become faster.
Good luck !
Appreciate the question!
In 2004 I joined my high school cross country team, running was fun, life was peachy. During my 3rd year of competitive running I began having pain in the ball of my right foot. I attributed this pain to the fact that I was, at the time, running in extremely worn out (literally holes in the soles you could poke your finger through) shoes, and the fact that everybody on the team was in pain. I thought it was normal. A bit over a year later, during an evening soccer practice I was once again wearing hand-me-down cleats that were FAR too tight (size 9 when I was a 10.5). I was kicked on the ball of my foot and it was excruciatingly painful like I had never before experienced. I went to a podiatrist and he eyeballed my foot, poked and prodded it, one spot in particular the lower back ball, and told me I had a minor bunion on my right foot and I was forming one on my left foot. He recommended inserts and told me they would cost $200 EACH. I wasn’t in enough pain to want to pay $400 for inserts so I just kept on keeping on. I ran mostly for pleasure during the next 5 years, only really noticing the pain when I went on lengthy pavement runs (I had much better shoes during this time.) 2012-2014 I began running much harder and consistently, averaging between 30-50 miles per week. The pain in the ball of my right foot was pronounced at this point and I was living in a city so I was doing a lot of pavement running. In 2014 I joined the military. During basic training I really had no choice but to stand… A LOT. I made it through the initial physicals and without problem but the standing at attention for so many hours started to irritate my foot. No movement. No shuffling to adjust for comfort no option to get off my foot and rest it. The result was swelling and pain that made it difficult to get my boot on and off and an extremely intense pain the arch of my right foot. It actually caused me to start limping a bit and it was extremely frustrating half the people thought I was faking and the other half just thought I was a wimp. I even thought maybe I was too, I mean 26 years old and being unhappy because a BUNION? I thought bunions were old people injuries! It pissed me off to be affected by something I thought was so minor. During the special physicals phase the first thing the doc had me do was take off my boot and looked at my feet. The big swollen red & hot ball of my right foot was blatantly obvious and the doc promptly cut me from the program. Around a year later I was back at home. Had been going very easy on my foot since being cut and had relatively no pain. Went on vacation to NY for a few days and walked many miles. All the pain came back, the ball of foot pain, and when I started to adjust my gait for that the arch pain that was like a nonstop cramp. When I got home I decided it was time to fork up the cash and do something about it for good. I went to a doctor and got x-rays and TA-DA I found out I have a fractured tibial sesamoid (i hadn’t even know what a sesamoid was before this). HOLY COW. It was like the lights turned on. It explained everything. The pain in the ball of my foot was always in ONE spot, the underside/back. I could actually FEEL the separate pieces of bone with my fingers and it was EXACTLY where all the pain had always been. The doctor suggested cortisone shots and after badgering him he also suggested moleskin pads. I was not interested in shots that did nothing but alleviate pain, I mean I’d put up with it for 10 years I figured I could wait a bit longer, however I did end up purchasing some Dr. Jill’s dancer’s pads. I did some google research and read a few blogs and articles about sesamoidectomy. My initial doctor had seemed apprehensive about any operation of any kind but after FINALLY know what was going on with my foot and causing the pain all these years I wanted it GONE! I solicited a second opinion, and this time I sought out what I thought was a well educated and best qualified surgeon who would have the confidence and experience to perform a tibial sesamoidectomy. The second doctor told me that the pain was caused not by my fractured sesamoid (which he believed was most likely genetic rather than the result of activity due to the pieces being rounded rather than jagged broken edges) but the pain was in fact caused by my bunion, because it moved the irritated sesamoid to underneath my big toe, rather than outside it. He reasoned that if I wanted to have any kind of surgery I should opt for the bunion surgery.
He Explained my Options as Follows:
Inserts
Bunion Surgery + Inserts
Sesamoidectomy was NOT an option. He told me any doctor willing to perform said operation was out of their mind and I should walk out of their office.
Here are my concerns:
1.) He is wrong. The pain is caused by my shattered sesamoid rather than by the bunion.
*It pisses me off that they think it was genetic. I HAD NO PAIN FOR THE FIRST 3 YEARS OF RUNNING AND THE 3 YEARS OF FOOTBALL PRECEDING THAT. My explanation for the rounded edges are the fact that I ran on this for 10 YEARS! Much like putting rocks in a grinder I think they probably did indeed start out as jagged but ended up being rounded out and ground down by the hammering they were given over the years.
2.) If he is correct, at my current rate I will need another bunion surgery in roughly 25 years, and another 25 years after that because nowhere in his plan do I see a solution to fix the CAUSE of the bunion. Even if I have the surgery I can’t walk flat like a normal person because I HAVE A BROKEN SESAMOID.
My initial goal was to get my foot fixed so that I could rejoin the military, which has been my dream my entire life. They won’t take me with a messed up foot. If I do this bunion surgery and it DOESN’T alleviate my pain I will have not only a painful foot but I’ll also have a screw in my big toe and a high potential for further injury in that area if I resume running. I honestly don’t know what to do. I’ll be honest I am terrified of having them saw open my bones and put a screw in for what seems to me like a 50/50 chance at getting better. If it doesn’t work out my dream is gone, forever. I am trying the boot now for 4 weeks, though it is doubtful I will see any kind of result. If the doc is correct and it’s genetic it won’t heal, and if he’s incorrect and it was indeed a fracture it is still highly unlikely it will heal after over 10 years. From the few articles I’ve read it seems that tibial sesamoidectomies in the past has been completed without incident, needing the skilled hand of a precise surgeon to do it without causing too much damage to the big toe tendon. I am tempted to hunt down a doctor that has performed a tibial sesamoidectomy and get a 3rd opinion. I just can’t accept that the options presented to me are the only ones. There has to be a better way. If there isn’t a better way right now then there damn sure needs to be a better way in the future.
I just realized that was quite the rant. I am open to attempting some barefoot time, though it seems counter-intuitive. It may be something I try after I give this boot a go. I can’t believe you did it with two messed up sesamoids. At the point you felt healed did the x-rays portray it? I am curious.
What a relief to find this informative piece! Though not a foot specialist, I am an expert at treating injury, inflammation, and pain. To get all the acupuncture I can cram into a day, and still have sesamoiditis pain…talk about frustrating. Thank you for sharing your experience and expertise, Dr. Nick!
I think that, like you, I’ve been suffering from this for years. It varies a lot, but is generally exacerbated by casual winter footwear (boots) for me. It also seems to bother me more when wearing certain running shoes. I have other various pains as well, including Morton’s neuroma, so I decided try the Topo Mangnifly for the wider forefoot. The good news is that the toebox completely relieves the nerve issues in my MN foot. The bad news, is that it seems to make the sesamoiditis way worse. For reference, I’m a flat footed mid-foot striker and do yoga as well as a number of at home foot strengthening exercises on a regular basis. I feel like I’m never going to find a pair of shoes that doesn’t bother me in some way.
Thank you. I am on the mend, having taken time off from rnuinng for 2 weeks. Now, it feels more like a nibble, than the immobilizing pain it was earlier. I have wide feet. Would you have specific recommendations for shoes? What is considered correct heel to ball size?Thanks again
Hi Dr. Nick!
In 2010 I visited my podiatrist due to foot pain. I figured I brought this on myself by wearing dress shoes and high heels to work for years. I was diagnosed with sesamoiditis. I was currently training for my first 5K race. I decided to stop running and stay off my feet until race day.
Turns out, my feet never hurt on race day nor did I ever have a trace of pain from there on out. In the following six years I have run 2 full marathons, 7 half marathons, and many smaller races without foot pain. I recently wore a pair of uncomfortable dress shoes (which I got rid of) and ever since then the sesamoiditis has flared up. I have stayed off my feet and recently started icing it. I think in my instance it’s not about the way I run. Is there anything else I can do to help control the pain? Thank you for any advice you can offer.
Hi Dr. Nick,
Thank you for this post! I have had horrible pain in the ball of my right foot for almost 4 years now. Last summer, I finally saw a doctor who referred me to a surgeon. I had an MRI and the surgeon told me it was a fractured sesamoid from “overuse” (I’m not a runner but I do exercise regularly and used to run stairs. I also work on my feet all day). He said I could get orthotics to take some of the pressure off of the area but surgery would be the only way to “fix” it completely. I basically went on with my life for the next year because both of those options were off the table at the time. I’ve decided that this summer (I’m a teacher so it’s the only down time I really have) is the time to really get my act together because I just can’t take it anymore. The surgeon has prescribed me a CT scan to see how much damage is done. As you wrote in your post, I’m really worried about the surgery and the damage that could happen from it afterwards. I’ve read stories of people being in worse pain afterwards and being even more limited. I’m doing as much research as possible and trying to find alternatives but it’s quite exhausting and I’m not sure where to even start. I do notice though that I have so much relief when I’m barefoot. The only shoes I’ve been able to wear for the last 4 years are Asics running shoes. However, after reading this, I’m wondering if they are the reason it isn’t able to heal?? Should I look into a minimalist type shoe to wear all the time even if I don’t run? Are there any inserts that you recommend specifically? Thank you for any suggestions! I greatly appreciate it.
Were you ever able to heal your foot?
Dr. Nick,
Thank you so, so much for this post! I was a half-marathoner until my sesamoid injury. I just saw my surgeon yesterday who wants to either lower my arch or remove my sesamoid (and he’s making me choose!). But I really get the sense that he is trying to treat my pain, not get me to a point when I can run or even walk pain free again. I’ve done the radio-isotope bone scans and MRIs and he said it looks like the bone is in about 6 pieces right now, so healing is just not going to happen. But for me surgery is the nuclear option. I haven’t heard of anyone even being active again after this surgery and it seems like most people end up with chronic pain. I just can’t live with that. After reading your post I’m looking for a running-focused physio and will pull out my vibrams again to see if there is any way this may work before I agree to surgery. Thank you so, so much!
I’ve had pain in my foot for the pst three years, finally went to get it checked out and my podiatrist says I have sesamoiditis. He told me in June to get shoes that don’t bend up, but I never did because it was tough finding he right ones. I work at an ice cream shop, that’s where the pain started. I came back to my dr in November and here is where he told me I have to wear a boot for a month as my final shot at fixing this. If it doesn’t work he said it is up to me to decide if I want surgery or not. I’m thinking about a second opinion but my insurance isn’t great and I don’t know if that’s an option. I’ve only had my boot in for a little over a week and I’m conflicted on the whole situation. Any comments or suggestions would be very appreciated. Ps. I’m not much of a runner, just on my feet constantly.
I had sesamoiditis for three years. Wore the boot but it didn’t do anything. I read John Sarno’s book “Healing Back Pain, the Mind Body Connection” and just applied what he said about the back to my foot. That’s what helped me. I’m good now. On my feet all day for work. I also agree to the philosophy of minimal shoes. I wear a thin flexible sole with no heal. I don’t have any problems.
Dr. Nick,
I can totally sympathize with your story. I am in a very similar situation. I have been dealing with pain for over 4 years. I was a completive D1 track and field athlete for 5 years and had surgery (removal of my fibular sesamoid) a little over a year ago, after I graduated. That might be one of my biggest regrets. The pain is back and worse than ever. It hurts to walk. I have tried everything and I mean everything: multiple cortisone shots, PRP injections, anti-inflammatories, steroid injections, oral steroids, surgery, Lazer light therapy, inserts, resting, acupuncture, ultrasound, icing, contrasts, stim therapy, and probably some more..
Right now, I’ve been in a boot for about 2 months. Doctors, no matter how much experience they have, don’t seem to understand how to diagnose/treat me. After finishing up some oral steroids and anti-inflammatories, I think I’m ready to try running again. But I want to do this the right way.
So I have many questions and would love your guidance.
Do you suggest I run in minimalist shoes to start with; slowly transitioning to fivefingers? Or just focus on form? I’d love a little more guidance on form as well. I have a passion for volleyball, field sports, and sprinting. Am I saying goodbye to those things forever? Have you completely cut out lunges, pushups or planks, jumping, and all motions that flex the toe? You recommend that I walk barefoot as much as possible? That’s how I am most comfortable anyways, but I am worried that favoring the outside of my foot will create imbalances. How do I go about strengthening my foot again?
I appreciate all of your help,
Dr. Nick…
I came across Dr. Jill’s dancer pads. Ballet dancers have this sesamoid issue and these pads help in that they force the foot to place weight off the sesamoid. I play basketball, yet tennis is the culprit in my case. Your conclusion regarding how to ” learn to run properly ” makes perfect sense. I have learned to adjust my footing when engaged in my sporting activity.
Great article. I have been dealing with this exact pain for over ten years. I initially blamed it on gout since the pain started around the time of my first gout attacks. I have high arches and have read that this is a factor in sesamoiditis . The only shoes I have found that have the high arch support yet cushion the ball of the big toe are Chaco sandals.
Best.Was it the shoes? Nope. I learned how to run. After another year or more of reading, learning (world wide collaboration of runners and physicians including Mark Cuccuzzella, Dan Lieberman, and Irene Davis) and now lecturing on this fascinating topic, I had finally got it. It has nothing to do with the shoes. It’s how you run. Yes I had strengthened my feet beyond what they had ever been my whole life, but the form I had now grown accustomed to was what was helping me.
This is indeed a great post. I have been searching for awhile now something that relates to my ongoing foot injury and I believe this is close to it. I have been running marathons and played multiple sports my whole life battling plenty of injuries but this one eludes me. I have had issues for a couple years within the tendon of the flexor hallucis brevis being constantly hurting when my big toe is bent upward. The tendon is “screaming” out of the skin of the foot when bent. I had multiple physical therapists and such work on it with no avail. After reading your articles, I’m assuming because of this injury, my Big Toe feels like it lost range of motion and I cant bend it downward as far as my other toe. A foot doctor thought I had arthritis in my big toe. Then came the sesamoid injury. I have a bipartite sesamoid and after an MRI the doctor said there is no fracture, just a ton of inflammation. I have been in a walking boot for the last 10 weeks and the dull pain is still there (The affected bone is the inner sesamoid). I am having doubts about the walking boot considering it ruins your gait and puts added pressure on the knees/hips/etc. I don’t have flat feet or high arch nor do I over/under pronate. I have not run since early June or played any sport since late February. I was considering going on crutches to hopefully alleviate any weight bearing on the foot but after your articles I’m having second thoughts. All in all though thanks for a very eye-opening informative post(s) with regards to sesamoid injuries.
Thank you for this post – still relevant after 5 years.
Initially I was misdiagnosed with Tendonitis, but an MRI scan showed I had potentially had sesamoiditis. It’s been recommended that I stop running for 10 weeks and was given an insole to wear, but it actually hurt my little toes to the point where I could barely walk. So I’ve opted for stiffer shoes.
One podiatrist recommended a pair of Newtons to run in, and I’m seriously considering barefoot running, my only obstacle being that I’m a heavier runner so I’m looking to transition. In the meantime I invested in a pair of Vivobarefoot shoes which have been brilliant – I actually experienced no pain walking in them, and I have worn them for a whole day without any issues, so I’m looking to get more.
I only started running a couple of years ago, in a pair of running shoes with an 8mm drop and had no problems. When I went to my local running store and told them what I wore, they were surprised first that I ran in them (including completing a 5km race) and didn’t have any problems. The salesperson didn’t feel they were proper running shoes (ironically they had them on sale in the store!) and recommended a pair of Brooks Ghost which were much more expensive with a 12mm drop.
So your story has made me feel that I’m on the right path. I’m not going to rush into anything and will be changing my existing running shoes. Thank you once again for your post!
I found your post after I was diagnosed with sesamoiditis w/o fractures by my podiatrist today. She told me not to walk around barefoot and called in a topical anti-inflammatory. I am tempted to order some five fingers, now!
Thank you for your informative post!
My 16 year old son is extremely active and was just diagnosed with sesamoid fracture. He has been in and out of a boot for 12 weeks and now says he has no pain when walking barefoot or in brooks ghost shoes. What is the next steps we should take. I am so scared for him to try running as the last time he tried around 6 weeks after injury it started to hurt again. Any suggestions.
Please remove my last name on your post
I know this is an old post. But happens that as a barefoot runner I have no issues with my feet. Can run for miles on concrete and I am fine. But since I been lifting more as a warm up I was using the stationary bikes at the gym since treadmills and elliptical don’t enjoy them. But this week I was bored of the bike so for 3 days in a row I used the elliptical and the treadmill as a warm up and some cardio after my heavy lifting and ouch! My left big toe is in real pain today! I can walk but instead of wearing my xero sandals I put the soles on a pair of water socks I wear for work since I cannot wear regular shoes anymore since my feet developed and toes spread like gorilla feet. Is it that those machines can be that bad???? I mainly use free weights and rarely machines. Thank you in advance for your help.