- Amount of arch to use
- Amount of stiffness across the ball of the foot
- Amount of dancer's pad to use to off weight sesamoid
- Amount of varus cant at the heel (inversion) to center the weight as you push off
- Amount of softness
- Amount of stability needed from the shoes versus orthotic devices
Dr Blake's comment: If you do not have the right orthotic in my mind, you are doomed to re-aggravate the sesamoid again and again. Once injured, it can heal, but the original injury shows that it is a vulnerable spot in your body (weak link in the chain!!). I am hopeful that this setback will get you on the road to finding the right orthotic for you. That is paramount!!
I'm not sure if I should be considering removal of the sesamoid or if it's normal to have flare ups and I should just accept this and when it happens, rest, ice, strengthen calves, etc? My hip has also started to hurt so I can tell that my gait is altered.
Dr Blake's comment: Removal of the sesamoid without the proper orthotic post op, which is the same orthotic you would use pre-op to hopefully avoid surgery is not a great option. It is done so so often, but there is a reason why your sesamoids are a weak spot. We do not know why it is vulnerable, but it is. You need to find out from your treating docs why it is vulnerable--plantarflexed, over pronation, hallux limitus, etc.
Dr Blake's comment: You bring up a good point. Our biomechanics are different in every environment--shoes, shoes and orthotics, barefoot, etc. Many problems are related to motion or shock absorption or stiffness. It is up to you and the treating docs/physical therapists to decide how safe you are in various environments with various activities. Some activities are better barefoot, some with shoes, some with shoes and inserts. I hope this helps. Rich