Sesamoiditis: Email Advice

Hello Dr.Blake,

I was hoping to get some advise on my issue with sesamoiditis and from
reading your blog you know your stuff.

I am a tennis player, about a 5-6 weeks ago I started playing in a new
pair of Nike tennis shoes. I already used up a pair of the same model
without any issues, after about an hour of play my foot started to
hurt pretty bad and after another 30 min I had to stop. The pain
subsided by the next day but after hitting with a new pair of shoes
because I assumed the shoes caused the pain, I got the same pain back.
The pain subsided by the next day, this happened for about 10 days, at
which point I stopped all activity and took a week off, after another
week(two weeks of rest) my foot was still hurting. I saw a doctor and
they said it was sesamoiditis. I've been on anti inflammatory medicine
and custom orthotics for 3 weeks now and a total of 5 weeks of rest,
with only weight lifting, no running, jumping or pushing off or
loading my foot. I have been icing, doing rehab exercises and wearing
the orthotics.

The pain is significantly lower but if I put my weight on it I can
still feel a small amount of pain, but it feels different than before,
it's pain that doesn't bother me as much and cause a guardian effect
and can see myself playing with it if needed without hindering my
performance. The pain before the rest period prevented me from doing
certain things.

This screams the 80% healing in 20% of the time and the 0-3 pain part
on one of your posts. Is there any point in resting it more, or should
I start playing tennis and gradually increasing amount of time
playing? My concern is that i have a high tolerance for pain and it
might be worse than it feels. Do I need to wait for all pain to be
gone before resuming?

Is there any point in seeing a doctor for my second visit? They told
me if its not feeling better by 3 weeks of rest to consider a
cortisone shot, but I really don't want to have one if possible. My
foot is feeling better, I just feel at this time it may take a long
time to actually feel no pain unless I just wake up one day and its
fine.

What are your thoughts?

I'd appreciate any advise and I apologize if this is not an
appropriate email with so many questions.

Sincerely,

Dr Blake's response:

     Thank you for the great email. You need to look at this 2 weeks at a time. What is the 2 week goal we should set? Since you love your tennis, only back to hitting and practicing only. You ice after for 30 minutes then another icing later that night. You go every other day, and give yourself 48 hours of recovery. You pain can not go over level 2-3 out of 10, and you want to be able to be the same by the next day. You stop playing/practicing as soon as the pain increases while playing. You should be playing with spica taping, orthotics, and some version of dancer's pads with the orthotics. This 2 week goal introduces tennis, tries to control the stresses through the sesamoids, tires not to have pain increase, but does not necessary try to eliminate all pain. If you have a high pain threshold, you may need to be more controlling. Try to really listen to your Body. This method does not ignore pain, just accepts some level is okay. Good Pain. 

     I sure hope you can see the starting point. Let me know where you are in 2 weeks. Dr Rich Blake

Sesamoiditis and Hallux Limitus: Email Advice

Hi Doctor,

I've been following your blog closely and I greatly appreciate your helpful optimism and passion to tackle people's ailing foot problems.  I was hoping that you could enlighten me with your opinion on the "Cluffy Wedge". I've pasted a link here http://www.cluffyinstitute.com/. I am struggling with sesamoiditis and hallux limitus, and so far I have found some relief with custom made orthotics from my podiatrist and a handmade, felt version of a dancer's pad which I wear with sturdy soled Dansko shoes. I tried the spica taping from your video with the kinesio tape, but I am unable to have it hold my feet in a sturdy and still position. It seems like despite bringing my toe down and taping it securely, it starts to come lose when I walk because of the necessary flexing motion of my feet that occurs. I stumbled on these cluffy wedges at the Good Feet store here in San Francisco and I thought I might as well try them. However I tried doing some research, and aside from their own site, I can't find many critical evaluations of the product. Are you familiar with them? And in your opinion, could it help with my sesamoiditis and hallux limitus? 

Thanks so much,

Sharon (name changed)

Dear Sharon:

     Thanks for sharing about the Cluffy wedge. Dr Jim Clough was one of my students, and I remember him well. How fun!! There are 3 or 4 very positive effects of his wedge that I put occasionally on my orthotics, but one big negative. The negative, based on how you use your big toe, the Cluffy Wedge may put too much back pressure on the sesamoids and increase the motion across the big toe joint when it should be lessened. These are normal aspects of working on the delicate biomechanics of the orthotic and shoe interface. I have routinely needed to have 3 different orthotic and padding combinations for the 3 main shoes a patient uses. Some made need the cluffy and dancer's, some Morton's extension, some greater arch support, etc. Now that you have written, since I have never actually called the padding I use a Cluffy Wedge, I will begin giving credit where credit is due. Also, try 3M Nexcare Waterproof tape, usually sold at Walgreens, for better stability when taping than Kinesiotape. Hope this helps. Rich