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Thursday, February 21, 2013

Sesamoid Pain: Email Advice

Dr. Blake,

Thank you for being available through your website. Any help is appreciated more than you can imagine.

I am a highly elite competitive runner and I am experience issues with the medial sesamoid bone in my left foot. I had what was diagnosed as sesamoiditis back in 2010 and wasn't able to run for around 4 months. It was much worse in 2010 than it is right now.  To fix the problem I switched from a neutral shoe to a stability shoe and also got general superfeet insoles to help with over pronating. It worked well and I had no problems for over 2 years even running a ton of high mileage weeks, but it came back again here while I was only running very low mileage recently. I am desperate to get something figured out and I have a very exclusive high level team looking to add me to their roster but nobody wants to take on an injured runner..

Typically I run anywhere from 80-120 miles per week but I am barely able to run at all right now. I was running off and on to manage it but it wasn't getting better so I took 12 days completely off, then started back up but the pain returned by my 5th day of running. I have since took another 10 days off and began to run again yesterday. Only 2-3 miles.
Dr Blake's comment: You definitely want to establish a baseline of pain free running. For right now, run every other day, with cycling on the off days, and never run through pain. The initial soreness is fine. Ice for 20 minutes right after running, and several more times that day. Ice 15 minutes twice a day on your off running days.

There is still minor pain in the area but I am having a hard time figuring out whether I should be doing any running right now. There is minimal pain when running and Spica taping the toe to immobilize it while running seems to help reduce the pain. It does however hurt a bit when walking around, and there is always a 'feeling' there, no so much pain but just a feeling of it not being 'right', if you know what I mean? The problem is when I had sesamoiditis in 2010 it was still painful when I first started running again and I simply had to work through some residual pain during my first few weeks back. 
Dr Blake's comment: A runner needs to run in their rehab, even if it is one second!! The pain that injures or aggravates is not mysterious. Find what is bad pain, pain that does not allow you to run comfortably the next day, and modify your workouts until you stay below the threshold of injury (the Good Pain Zone). 

Right now I am doing spica taping daily, ice massaging with an ice cup 4-5 times per day, ibuprofen, theraband inversion eversion, etc, drills, toe pickups, wearing a metatarsal sleeve (this one -, and staying off of it as much as possible.  I have an appointment with a Podiatrist in Portland, OR who is a former high level runner but he didn't have any openings until late March so I am stuck waiting until then. I am almost certain it isn't a fracture because it feels just like 2010, only not as bad.
Dr Blake's comment: Use the ibuprofen very cautiously, since it can slow down bone healing, if there is a bone injury. Let me know if the sleeve works so I can recommend it. Do you feel that the inserts you are wearing is adequately protecting you? The insert should be shifting your weight on to the center of your foot and somewhat off weighting the sore area. Check the American Academy of Podiatric Sports Medicine website for a podiatrist in Portland, if you want to at least get started with a sports minded podiatrist. 

Is there anything else that you could possibly recommend to me to help speed up the healing process? 
Dr Blake's comment: You need an MRI to help sort out this problem, but you may not like the findings!

What about a cortisone shot, is that something I should look into with another podiatrist who can get me in sooner? Are they helpful in clearing up sesamoiditis? Is that something you recommend to patients ever? 
Dr Blake's comment: Cortisone shot only with a negative MRI and only with several months of no running, so basically "bad idea" in this situation. 

I really can't afford to take another 4 months off as I've been trying to get on one of these teams for years and the offer has finally came up and likely won't be available to me ever again as I'm already 29 years old.
Dr Blake's comment: You are so young, but I hope you can fulfill your dream. That is way too much running--over 70 miles per week. I thought runners were doing less distance and more quality now a days. When i was young, over 70 miles per week was normal, but boy did we get beat up! I am a wimp, however.

Thank you so much for you're time

Dr. Blake

In my previous email I forgot to ask..

Will doing theraband drills that cause bending of the first met/big toe cause harm? I al doings in bending the toes forward and backward against the resistance of a therband...
Dr Blake's comment: It is not mysterious, listen to what your body is telling you. Sounds like it is fine. 

Also, what about rolling out the area with a golf ball? I have been doing that as well to break up the tightness. Is that bad for it?
Dr Blake's comment: Listen to your body, and if there is soreness back off, even physical therapists have a hard time knowing at times what is good pain and what is bad pain. Hope all this helps you. Rich


  1. I found the padding in the sleeve much too thin to off-load the sesamoid alone. I do sometimes wear it with an orthotic with a first-ray cut out to lift things a tad more when I feel the need.


  2. Dr Blake,

    I'm with Devon on the sleeve. I also tried it, and found it was way too thin. And, even though I'm a dancer and wear lyrical half-soles that are similar in structure, this sleeve was super uncomfortable and made me walk funny (which just aggravated my sesamoid injury more).
    I found the Moore Medical sesamoid pads a lot more comfortable and helpful for my sesamoid injury. Plus they come in large bags, so I had more to work with. Here's the link to what I was using:



Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.