Orthotics 4 Foot and leg Pain

Sesamoiditis is not a diagnosis you make on your own.  Either your doctor has given you the diagnosis or through much research based on where your pain is located, you have come to the conclusion that possibly you have sesamoiditis.  Sesamoiditis means inflammation of the sesamoid bones which are two bones located just under the head of first metatarsal bone.  Whoever was responsible for the design of the human body did not put much thought into the placement of these two bones.  They act as a lever system for the flexor tendons of the big toe whose job is to help bend the big toe downward.

sesamoid bones of human footThe problem with these bones, due to their location, is that they are subject to trauma for a number of reasons, the first being their location.  Some people have their sesamoid bones a bit further back from the head of the metatarsal bone, while others have them a little bit closer.  The closer the sesamoid bones are to the actual head of the first metatarsal, the greater the chance they will be strained or injured.

Secondly the size of the sesamoid bones also plays a role in their ability to become painful.  The larger the size of the sesamoid bone(s), the more likely they will be irritated from the walking surface.  Some people even have what is known as a bipartate sesamoid which is a condition where there are actually two bones that appear to be one big bone that looks like it is fractured.  Again, this too will contribute to sesamoiditis.

Certain types of foot structure can make sesamoiditis more of an issue as well as lack of fat padding on the ball of the foot.  Those with little to no fat padding may actually be able to feel the sesamoid bones if they press in that area.  So, if you can press with your finger on the bottom of the foot and actually feel the bone, imagine what happens to these two bones when they are subjected to countless pounding on the walking surface and certainly exacerbated in those who are athletic.

Like metatarsalgia, wearing thin soled shoes or wearing high heel shoes will contribute to the onset of sesamoiditis.  Wearing a good cushioned shoe like a sneaker will usually make the problem less painful.

Many times wearing a rigid soled shoe that has little bend at the forefoot will also help a person deal with sesamoiditis.  This means if you can keep the big toe from attemping to constantly bend upwards during the gait cycle, you will go a long way in reducing the strain on the sesamoids.

how does an orthotic help sesamoiditis?

Like most musculo-skeletal conditions there is varying degrees of pain in sesamoiditis.  If wearing either a stiff soled shoe or better yet a stiff soled sneaker with a cushioned innersole, you might get the relief you are hoping for.  Problem is many people cannot wear those types of shoes on a regular basis, or if the sesamoiditis is more severe you are going to need the help of an orthotic.  Additionally some people develop sesamoiditis secondarily to the sport they participate in, so in order to keep "playing" an orthotic will have to be added to the athletic shoe.

An orthotic accomplishes two things in lowering the pain of sesamoiditis.  By supporting the whole foot, the orthotic takes some of the pressure off of the sesamoid bones.  More important is the padding that needs to be added to the orthotic.  We add what is commonly known as a dancers pad.  This is a pad that is incorporated into the orthotic or in acute cases of sesamoiditis can be placed directly on the foot, to take ground pressure off of the sesamoids.  We refer to this as letting the sesamoids float.  In conservative treatment of sesamoiditis this is where most people end up.dancer pad

The problem with sesamoiditis, like a lot of foot and ankle conditions, but probably more so than others is that just regular walking continually aggravates the problem and this condition in particular can remain an ongoing problem because the sesamoids just never have a chance to adequately heal due to everyday walking.

I do not know of any store bought arch supports that offer a built in dancers pad.  The only value I see in a store bought arch support might be the cushioning that the device affords to the forefoot.

Off the shelf medical grade orthotics can have dancers pads added to them by a qualified podiatrist but in most cases the pads will have to be replaced over time as they will either wear out or shift position.

In sesamoiditis that does not respond to simple care and requires an orthotic I tend to find that a prescription orthotic is the best choice for two reasons.  The dancers pad is placed in the exact spot and because it is built into the orthotic, will not move or wear out over the short term.  This is particularly important in those individuals who will be wearing orthotics in their athletic shoes.

Although it is beyond the scope of this article, when dealing with sesamoiditis it may be necessary to rule out a stress fracture of one of the bones.  Many times they will not show up simple x-rays and either a bone scan or an MRI will be necessary.



ORTHOTIC RATING:

store bought arch support usually not much help because the sesamoids need to be accommodated

medical grade off the shelf orthotic good for short term relief because accommodative pads will need to be added but these types of pads do not last forever.

prescription orthotic most effective and probably the way to go with sesamoiditis

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MEDICAL GRADE ORTHOTICS

best buy in pre-made orthotics for sneakers, work boot and casual lace shoes

KLM SuperStep Orthotic    

best buy in pre-made orthotics for womens flats, low heel pumps and mens dress shoes

Redithotics 3/4

medical grade off the shelf childrens orthotics because kids outgrow orthotics so quickly

childrens orthotics



Copyright © 2013. All Rights Reserved.Marc Mitnick DPM