A letter from Maggie, really bad sesamoiditis

Hi Greg,

I don't know if you will have time to write me back, or if you actually write people back, but I'm taking a shot in the dark because I just bought and read your book (PDF version) about sesamoiditis, and as I have for the last nine weeks, I want to cry because I am so frustrated. I am a Canadian who is making a special trip to see a sports medicine doctor (who is also an orthopedic surgeon) at Cleveland Clinic on Monday. I don't know what I'm going to do. I feel like I've done everything, and this is never going to get better. I just began the acupuncture (four sessions so far), and I ordered the TENS machine and bought rocker shoes (although I'm using crutches now).

I was wondering why you didn't mention MRI in your book. Is bone scan preferable to MRI? I'm booked for an MRI on Monday (an x-ray was normal), but now I think a bone scan is what I should get. You also didn't mention if swimming or pool running is ok because I did this for the first few weeks, and here I am, into the third month with this injury, and no better, so maybe the pool wasn't good either? What are lifelong athletes supposed to do if they can't even swim? Or do yoga (no toes)?
If you have any time to reply, I thank you sincerely. I am so completely despondent that I honestly don't know what to do.

Thank you.
Maggie

A Letter from Annette: No acupuncture or ultra-sound

Hi Greg,

I read your book last night. After seeing two podiatrists and getting somewhat different information, I kept searching for more info and hoping that a boot, rest, and an orthotic wasn't the only solutions. I have to admit, I am really bummed. Especially today. I am a runner. Not an ultra runner, just halfs. But most of the time, just 3-4 miles for fitness and fun. I really enjoy it, but right now I'm out of commission. I have been dealing with this for two months and did pretty much everything you're not supposed to do. This stupid problem is not high priority for podiatrists, at least the two I saw. Also, it just seems like podiatry is in the cave man days. I cannot accept there isn't something better than the standard advice. I have aggressively searched for answers.  It's like stumbling in the dark. So I bought your book. And I have prayed about it and asked others to. 

My question is: what if I cannot do acupuncture or ultra sound? What if I do everything else? I'm asking because I doubt my insurance will pay for it. 

Thanks for writing the book.

-Annette

A letter from Jerry, a frustrated high school student who plays baseball and has sesamoiditis

From: Jerry

Hi Mr. Unger, my name is Jerry Carroll. I recently bought your book on sesamoiditis. I play baseball and it is so frustrating to play with this pain. I have a bipartite chronic fracture in the sesamoid. I wear orthodics from my foot doctor, but they're not really doing anything to help the pain and inflamation. It would be very much apreciated if you could take some time to answer my questions. What kind of sesamoiditis did you have? How much tumeric should I take? Does doing 3 times of ibuprofen a day going to be that much different then 4? How do I do acupunture and ultra sound back to back, for example is there a doctor that has both of those tools with them? And does this 2 week regimine take away the pain for a short period of time, long period of time, or forevor. What has your experience been like with your program?

---

Jerry,

All of these answers are in the book. I will repeat them here.

What kind of sesamoiditis did you have?
I had sesamoiditis in both feet. Minor fracture and deformity of the sesamoid bone which made it look totally split on the x-ray.  I was in pain just walking/standing and tried to never walk barefoot which really hurt.  I opted not to have crutches but you may want 1 crutch until the fracture is gone.

How much tumeric should I take?
1000mg of tumeric as long as you feel no side-effects and no stomach problems – 2 times per day
** Do not take ibuprofen AND Tumeric.  One or the other.  They are both taken to hedge against inflammation and are not healthy to take simultaneously.

Does doing 3 times of ibuprofen a day going to be that much different then 4?
• Yes it does. You need to keep the level of anti-inflammatory (ibuprofen) in your system constantly.  200mg tablets are effective for 6 hours max.   If you sleep 8 hours then just dose up as soon as you wake up and right before bed.
• If you have acid reflux problems (heart-burn), take the ibuprofen with an ant-acid (zantac)
• Do not TAKE ibuprofen indefinitely.  You will want to cycle it for 2 week periods.  This will help you to determine where you are at pain-wise as well when you get off of it.  The amount you take depends on your size, age, effect… Do not take more than 1000mg per dose.   Taper the dosage as well… Example:   Week 1: 1000mg – 4 times per day, Week 2: 600mg – 4 times per day.

2 weeks on, 2 weeks off (Get off all anti-flammatories for a 1 day to check your progress (No tumeric and no ibuprofen and no icing.  Switch to Tumeric during your 2 weeks off once you have assessed how much pain is still there.  Also be sure to ice as often as possible, no more than 20 minutes per session.  Do not do ICE and then HEAT back to back ever.  20 minutes of ice on the ball of foot then 20 minutes with nothing than 20 minutes ice - repeat)

** Get a small bucket that will fit both of your feet… A storage bin container from Walmart.  Fill it up with ice and water and put your feet in that to ice it OR get Dixie cups, fill with water and freeze them and rub the ice on your foot..  OR goto walgreens and get the ice Velcro strap to put on your foot.

The ice bucket works the best.

How do I do acupuncture and ultra sound back to back, for example is there a doctor that has both of those tools with them?
Try acupuncture and STIM-acupuncture (STIM is electrodes hooked up to the pins) to see which one works better for you.     Find someone who does both.

Acupuncture treatment first followed by Ultra-sound for like 10 minutes followed by massage (Hard but not hard to hurt the area), follow this by ice for 20 minutes.
** Do not run, walk a lot or carry anything heavy on the days you do acupuncture, you could do more damage than good.  (basically anything that irritates your balls of feet on the days you do acupuncture)

And does this 2 week regimen take away the pain for a short period of time, long period of time, or forever?
It reduces the inflammation and with less inflammation you will have less pain.   The fracture has to heal 100% before the pain will be gone forever.  You are doing the 2 week regimen to help the fracture heal and to keep the inflammation down because you are causing inflammation whenever you put any pressure on the ball of your foot for any reason (standing, walking, lying in bed causes problems if your foot isn’t elevated)

Eventually the pain will be gone forever if you stay on top of this.  While you have a problem the pain will come back as soon as you get off the ibuprofen or as soon as you walk on it funny and hurt the area.   You can test your pain best by walking barefoot for 20 feet or so on cement.

What has your experience been like with your program?
2012 – 50+ Marathons and Ultra-marathons (up to 100 mile runs)
2013 – 50+ Marathons and Ultra-marathons (up to 100 mile runs)
2014 – 50+ Marathons and Ultra-marathons (no 100 milers until next month)

I got the sesamoiditis in May of 2013.   As I said, walking, standing, etc. hurt my foot but with what I detailed in book, I was able to run long distances because I switched my foot strike to a mid to back foot strike which means I wasn’t hitting the balls of my feet when I foot strike to run.

You cant change your foot strike when you walk because it wont feel good.  Running like this is different in case you need to stay in shape for baseball.

** Swimming laps and doing hard sessions on a indoor SPIN bike will help to keep your cardio up and not put pressure on the foot.  i.e. Cross-train

So the lesson is Walking, Standing, Standing with weight in your hand, putting any direct pressure is bad.   Anything you can do that takes the pressure off the ball of your foot is okay.  You will know if it hurts.

You have to stay on top of this for it to heal otherwise it can literally take years, surgery or it will never heal right and it will always hurt.

Last but not least…. Ditch whatever orthodic the doctor gave you and go find a Sports Pedorthist… This is very important.  The Sports Pedorthist is a master orthodic maker and can keep adjusting the orthodic until all the pressure comes off of the ball of your foot when you walk.  Bet on about $200-400.  You should make sure you put these in your walking shoes.   If you can run in them great but I have found it hard to run with these so I use a normal sports/running orthodic from the store in my running shoes.  You walk way more than you will run anyway.

If you really think your orthodic from the doctor is working and you have no pain walking than use it but if you have any pain while walking in that orthodic than spend the money and go to the Sports Pedorthist.  Google one your area or find one close to you so you can go into the store and get measured by him/her and so you can go back if you need adjustments made.

** The fracture has to heal before you should even try to run.

Stay off of it until the fracture heals.  Go back in and get a new X-Ray done to see if it has healed in a month.

** You might want to try a different Sports Orthopod or Sports Podiatrist to give you a second opinion on whether or not you truly have a fracture as opposed to just being born with it deformed which can look JUST like a fracture (I was born with deformity and a LOT of people have this).

I hope you get over this fast.  It’s a terrible problem to have.   No one likes to be side-lined by injury.   Make sure you keep your spirits up.

Take CALCIUM supplements and STAY AWAY FROM CAFFEINE, any sort of drugs including nicotine, do not drink alcohol at all and try to eat healthy and organic meats and vegetables.  Stay away from SUGAR and try to follow a diet that is meant for anti-inflammation.

You do this to heal faster and you do this to help in case you get any sort of depression from being benched which a lot of people get.  If you find you attitude is bad or worse than usual, you are probably depressed.   Eating healthy will keep your spirits high and your attitude positive.

If you start to get a negative attitude your chances of doing everything you can to heal start to diminish. Stay positive.  Focus on healing and focus on what you will do once you are healed.   I know this might sound hokey but it isn’t. Believe me.  All of the major athletes spend a lot of time training their mind.

I hope this helps.

If the information works for you I would appreciate it if you could give the book a good review on Amazon.com

http://www.amazon.com/The-Sesamoiditis-Cure-definitive-understanding/dp/1495466108/ref=sr_1_4?ie=UTF8&qid=1412812659&sr=8-4&keywords=greg+unger

Keep me posted and let me know how everything goes.

Greg

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Greg,

So did you have the same stress fracture as me because my fracture was said to be never curable because I noticed it almost a year after the fracture. So do you think the fracture in the sesamoid could just go away. Just curious, does your sesamoid on an x ray show no more fracture after you did the 2 week regiment?

---

Jerry,

Yes on my left foot I did have a fracture but it was a hairline fracture not a complete break off of the bone.   If you have a complete break you will most likely have to have surgery to repair or remove the bone.

Nothing will cure a complete break, you will need surgery if it hurts and you cannot play sports.

A hairline fracture should heel but I am not your doctor so I would seek a second opinion if that is what your primary doctor said and see a specialist.

It not being curable doesn’t make any sense.  If you noticed it a year afterwards it may be because you never let it heal properly and kept re-fracturing it.  It needs to heal properly. You need to stay off of it.  You may need it casted.

My book and advice is what you do to heal faster but nothing is going to fix a fracture in 2 weeks.  My book also details how to not re-fracture the foot by staying off of it.

Curing this is not a 1 day problem and its not a 2 week problem.  It may take longer and will if you still have a fracture.

Once the fracture is healed there will still be a lot of work involved to get rid of the pain in order to get back to sports.  You don’t have to fracture the sesamoid to have sesamoiditis.  Sesamoiditis can exist without a fracture and so can the pain, for a long time after any fracture heals.

Yes, I think the fracture (unless it is totally broken in half) will heal.  I have not seen your x-rays and cannot make a judgement call on your specific case.

Again, see a sports orthopedic surgeon or sports podiatrist and get a second opinion or even a third opinion.

My x-rays show no more fracture at all.

Good luck with everything and I hope that helps.

Greg Unger

A letter from Gary about his foot problems when he runs

Gary wrote:

Hi Greg,

Ran across your sesamoiditis cure book on the web. My pain only occurs during running or prolonged standing. Last April I got a pair of Chung Shi rocker shoes for running plus an orthotic from Foot Solutions, and that took care of the problem for 8 months. Since the pain returned in December, I’ve noticed that the Chung Shi compresses my toes, and I found out I do better with older well-worn  Asics shoes with a fairly wide toe box. The old shoes, however, still give some discomfort near the end of my 6-mile run (on back roads, mostly gravel/tar), which I currently do every other day. With no running or no prolonged (4+ hours) standing, I have no pain or discomfort at all.

So what I’m interested in is another pair of shoes with a wide toe box and a non-flexing forefoot and good cushioning under the forefoot, like the Saucony Hurricane 13 recommended by Dr. Jenny Sanders here: http://drshoereviews.com/2012/01/

In looking over the book preview, it looks like you’re giving a lot of therapies for treating the pain, but what I’m interested in is finding some running shoes to PREVENT the pain. Does your book have any advice in that regard?

Thanks, Gary

---

Gary,

I hate to hear it came back!  Prolonged standing will definitely cause major problems.  I actually cover standing and sitting with pressure on the forefoot in the book.   Both create enough of a problem that pain and inflammation happen.   

I looked into the Chung Shi shoes awhile ago but all the research I did led to a conclusion that they really didnt do anything for the majority of people (A few people liked them).   I am a math guy so I look at things from a probability standpoint to try and be as efficient as possible when coming up with solutions to things.

I personally use Asics Kayano's because they work the best for me.  If you look at the reviews (Shoe websites, amazon, etc.), you will find they are very highly rated and reviewed.

Altra's are made specifically to allow for a larger toe splay (toe separation upon strike) so they may be more comfortable for you.   Hoka's with orthodics work well too.  There is no shoe that by itself will be a solution.  You have to have the correct orthodic, room in the shoe and support from a good sole especially when running or standing for long periods of time.

You have to have plenty of room in the running shoe no matter what.   Keep in mind that you should be able to goto a wider size in regular running shoes because the orthodic should keep your foot in place and the "way" you lace your shoes should keep your foot snug and your toes from hitting the front of the shoe.

The correct shoe also really depends on your height and weight. (Height comes into play due to your nature center of balance when running, i.e. do you lean forward, back, etc.)

To answer your question, yes, my book goes over shoe solutions.

It covers orthodics.  Unless that orthodic was specifcally made for your foot "and" for your condition, it is not the best solution.   That might be evident from the fact that you still have pain.

The solutions I propose in the book allowed me to run road marathons literally every weekend with virtually no pain and I had sesamoiditis bad and bilateral. ( I race a lot ).  I also did the Leadman race series in Leadville, Colorado with it.

Long story long... 

You have to get the right orthodic for your foot "and condition". Also, you have to have someone who can tweak that orthodic until you have no pain.  The specific cause of sesamoiditis is a little different in everyone so tweaks need to happen even with a custom orthodic.

Staying off your foot completely (boot and crutches) for most people work.  I on the other hand have a real problem with being sidelined so I subscribe more to the "find a way" idea of getting things done.   

A few simple changes should get you back to running without any pain.    Standing for "long" periods of time has its own problem due to gravity (forcing blood down).   You must ice the ball of foot repeatedly to get around this problem.   Carry ice packs with you (in a cooler if needs be).  NSAIDs should be taken when you know the standing will happen.   Proactive is key.

Whatever you do, stay on top of it.   If some action hurts you have to stop it until you find a way to do the action without pain or inflammation.   i.e. I am not saying to stop the action, I am saying to find a way to do it without pain :)

I hope this helps... If you buy the book, great... You are supporting my race registrations ;)  If you don't buy the book then I sincerely hope the problem goes away for you.   I can't stand when anyone is sidelined.   

If you do find a way that works for you keep me posted.  I would love to hear about it.

Greg

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Hi Greg,

Thanks so much for your very detailed and helpful reply.

The same day after I emailed you, I found a local store which I hadn’t previously been aware of which carries the Altra shoes.

The owner, Jeff, has quite a few years of experience with fitting running shoes and helping people with foot issues.

When I described my history and problem, he thought it might be Morton’s neuroma rather than sesamoiditis. He watched me run and noticed that I tended to strike the floor with my whole foot rather than heel to toe. Long story short, he put me in a pair of Brooks Ravenna 5, size 11.5EE (my usual shoe size in 10.5 to 11). When I ran 6 miles the next day, I had NO foot pain at all and not even a sensation that the ball of my foot was bothered at all. Two days later (yesterday) I ran 5 miles with the same result. And for the rest of that day and all day today, I’ve spent most of the day standing or walking around and have not had any discomfort, even without using my orthotics.

To clarify, I’m now running in the Brooks shoe with the wide “stabil step” orthotics I got off the shelf at Foot Solutions along with New Balance Supportive Cushioning Insoles (IUAS 3810 -Previously Ultra Arch).

I won’t say this is a permanent solution until I have at least 6 pain-free months, but it appears I’m on the way towards one, at least.

I’m still not sure (and I don’t think Jeff is, either) whether my problem is sesamoiditis, Morton’s neuroma or metatarsalgia, although maybe all of them have similar methods of prevention and correction. Does your book cover the other conditions as well as sesamoiditis?

Thanks again for taking the time to write me such a thorough and considerate response. 

Kind regards,

Gary

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Hi Gary!

Great to hear Gary! Yes, my book covers all of the best modalities for treating mortons neuroma, seismoditis, turf toe and more! For a few bucks it is worth the read!

Thanks

Greg

Reduce pain & swelling with cold compression

The 1st step for conservative treatment of your sesamoiditis is to reduce the swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required to heal sesamoiditis injuries. This is why for years doctors, trainers and other medical professional have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.
Cold Compression Therapy slows nerve and cell function - reducing the swelling that blocks blood vessels from doing their job. This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through the tissue and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues as the cells don't get the oxygen they need to survive. By limiting the amount of damage done to your tendon, you also limit the amount of healing that needs to occur. This is a very important step to heal tendon injuries faster and with less pain! This is why you need to treat your sesamoiditis foot pain right after it's hurt, when you notice pain / swelling / inflammation, or directly after a re-injury. Applying cold compression right away will stop the damage immediately and unblock your blood vessels to let your body's natural blood flow in to start healing the tissue.

It'll seem weird for you to read this, but there are a LOT of people out there that don't understand how fast cold compression can get the swelling / inflammation around your sesamoid bones under control! After you get rid of the swelling for good you can start dealing with your sesamoid injury and pain head on.

24 to 72 hours after your initial injury or when you first notice pain and swelling in the ball of your foot to stop cellular damage, relieve pain, and decrease swelling.

1. After exercise, workouts or activity of any kind to prevent re-injury of your sesamoids.
2. Before and after surgery during rehabilitation to control pre and post-surgery pain and swelling.
3. Anytime you feel your sesamoiditis has made your foot tender, painful or you're having a flare-up of an old sesamoiditis injury.
4. Anytime you have swelling, sharp throbbing pain or inflammation in the ball of your foot.
5. Any other situation where you need to draw the pain and inflammation out of your foot.

What if You Need Surgery?

Whether you need to have surgery and the type of surgery you'll have depends on the severity of your sesamoiditis and whether you have a fracture in your bone. The longer you've waited to have surgery or try conservative treatment methods will also be a factor to decide if you need surgery.

Has it been weeks or months since the injury?

An acute (recent) case of sesamoiditis is usually treated with conservative treatment methods, like rest, minimizing activity, cold compression and Blood Flow Stimulation Therapy^™ as we mentioned before.

Doctors and surgeons will always avoid surgery if possible because recovery from the surgery can be a lengthy process, in most cases your sesamoid bones will have to be removed reducing the mobility of your foot. Doctors always prefer minimally invasive treatments which is why they suggest conservative treatment first. Your doctor and surgeon know that a surgery will involve altering the structure of your foot, and so they will recommend treatment to avoid surgery at all costs.
If you have a fracture that's not healing of you have a fracture that puts your bone in multiple pieces, your surgeon might perform a sesamoidectomy (removal of the sesamoid bone).
Scar tissue will be problematic for long-term recovery after surgery.

As with any surgery there are risks to every procedure depending on a lot of factors, including your age, the severity of your injury and your level of health going into the procedure. It's always best to discuss all possible risks and complications with your doctor, orthopaedic specialist and/or surgeon before the procedure. It's important to be aware of the risks you may face with any procedure intended to fix or relieve pain from your sesamoiditis.

Sesamoidectomy

If you suffer from a regular (acute) fracture or stress (chronic) fracture in your sesamoid bone and conservative treatment methods haven't been successful in healing or relieving pain, then your doctor may suggest a sesamoidectomy surgery. During this procedure your fractured or injured sesamoid bone (or pieces of the bone) will be removed. Removal of this bone is meant to ease pain and promote healing in the area.
This procedure will be done by making an incision on the side of your big toe. The surgeon will then seperate all of the underlying soft tissues to get to your sesamoid bones and visually inspect it. Once removing some or all of your sesamoid bone the surgeon will use sutures to attach the end of the tendons together or connect it to the remaining bone.

One of the major risks of this surgery is how removal of your sesamoid bone(s) will affect the structure of your foot. Since the sesamoid bones act as pulley's on the bottom of the foot for tendons that control your toes, removal of one or both of these bones will remove important leverage needed for the foot to work properly. There is always a risk that removal of your sesamoid bone(s) could affect the shape or angle of your big toe. You might end up with 'claw toe' (where your big toe is bent up) or your big toe could slant towards your second toe. You could also end up needing to have the rest of your sesamoid bone left removed if it gets fractured in the future.

This is why doctors encourage conservative treatment methods first, and surgery only second IF the conservative methods of healing don't work.

Sesamoid Bone Graft Surgery

The only other option for sesamoid surgery is a bone graft. This is usually only performed when you continue to have issues with a stress (chronic) fracture in your sesamoid bone(s). During this procedure your surgeon will take some bone from big toe (this is called an 'autogenous bone graft') through a second incision, and then use that bone to repair the areas that aren't healing properly in your sesamoid.

Sesamoidectomy is always preferred over a bone graft as it's a minimally invasive surgery. This bone graft procedure is also only ever considered for high performance athletes.

Your rate of recovery after the surgery will depend on how dedicated you are to the conservative treatment method recommended by your doctor, the type of procedure that you had and your efforts in physical therapy.

No two rehabilitation plans are alike - Generally speaking the less invasive your
surgery is, the quicker your road to recovery will be.

• Sesamoidectomy - You may need to wear a cast for 2 to 3 weeks, then follow that with a walking brace for another few weeks. Physical therapy can start 2 to 3 weeks after your surgery and you may be able to return to some modified form of your regular activity by week 8.

• Sesamoid Bone Graft Surgery - This procedure will have a longer recovery period, starting with you wearing a cast for 3 to 4 weeks. That's followed by a walking cast or boot to be worn for another 3 to 4 weeks. Physical therapy may start anywhere from 4 weeks after surgery to 8 weeks after surgery. Other assistive devices like orthotics or arch supports may be prescribed to help you along with your recovery.

What if You Don't Have Tendonitis or a Fracture?

There are 3 more injuries that can happen in or around your sesamoid bones resulting in sesamoiditis pain:

• Intractable Plantar Keratosis (IPK) - this is like a callus or corn that's formed on the ball of your foot under your big toe that can cause sesamoiditis-like pain. Over time this callus / corn can develop into a larger lesion with a very painful sore-spot in the center.
  
  If left untreated, this condition can lead to a more serious sesamoiditis injury, reduce range of moition / mobility of your foot and change the way you walk on your foot. Conservative treatment methods are used to treat this injury. Surgery is only ever recommended if you continue to feel pain and have reduced range of motion even after using conservative treatment methods.

• Osteochondritis (Avascular Necrosis) of the Sesamoid Bone(s) - This is a condition where blood supply to 1 or both of your sesamoid bones isn't available. Over time reduced blood flow to your sesamoid bone can actually cause a portion of your bone to die (this is also called 'necrosis'). Your body will try to heal this injury by building up extra calcium (bone) around the dead spot.
  
  This can sometimes happen if you've suffered from a chronic ("stress") fracture in your sesamoid bone that hasn't healed properly. In most cases conservative treatment methods won't work to treat this condition and surgery will be needed to remove the sesamoid bone (reference: 1, 2). If surgery is required, conservative treatment methods can then be used during post-surgery rehabilitation.

• Nerve Entrapment - There is a major nerve that runs near our big toe and second toe called the 'Medial Plantar Nerve'. Even though this nerve is usually not close to the sesamoid bones, nerves can sometimes naturally be in areas where doctors don't expect them to be. It's possible to be suffering from sesamoid pain, with the pain really coming from your medial plantar nerve if it's running under one of your sesamoid bones. If you've had an x-ray and multple tests done to see if you have sesamoiditis or a sesamoid bone fracture and there is no definite result, you might be suffering from nerve entrapment in that area.
  
  Your doctor can see if you have nerve entrapment in this area by doing a test called 'Tinel's Sign'. During this test the doctor will lightly tap near the painful area to see if you feel any tingling or 'pins and needles' sensations. If you feel tingling that runs down your big toe, you might be suffering from nerve entrapment (reference: 1).

• Sesamoid Arthritis - Sometimes you may have cartilage damage under your sesamoid bones between your sesamoinds and the bones in your toes. This cartilage damage can lead to arthritis, a painful inflammatory condition causing stiffness and swelling in your joints. You could have sesamoid pain that is really a case of arthritis under your sesamoid bones. Any signs of arthritis around your sesamoid bones should show up in an x-ray.

What is sesamoid tendonitis?

Sesamoid tendonitis (sometimes spelled tendinitis and pronounced 'tendinitus') is irritation and/or inflammation of the tendons surrounding the sesamoid bones.

You will feel this irritation and/or inflammation when there is a strain, damage or micro-tearing in the tendon tissue.

Anyone can suffer from sesamoid tendinitis - for younger people it usually happens from repetitive movement of the toe in athletic activities like baseball and ballet. In adults, this injury can happen from over-use OR degeneration of the tissue as we age.


You could have different types of sesamoid tendonitis including:

• Tendinosis - a condition caused by chronic degeneration (wearing away) of the tendon fibers over time.
• Tendinopathy - chronic inflammation of the sesamoid tendon(s) that results from many small tears over from from over-use or repetitive movements.
• Tenosynovitis - damage or micro-tearing to the sheath covering the sesamoid tendon(s).

It's possible to have tendonitis / tendinosis / tendinopathy AND tenosynovitis at the same time, creating a more complicated sesamoid tendon injury.

Do you really have sesamoiditis?

Our feet are some of the most complicated joints in our bodies with 26 bones, 33 joints and more than 100 tendons, muscles and ligaments (reference: 1).
Big toe pain can be from injuries to the sesamoid bones or the soft tissue in the foot, some of the more common injuries being:

• Foot bursitis - Bursitis can occur in the toe joints, the side of the foot, the heel and around the ankle. As we walk, run or jump, the ground surface and the shoes we wear play an important role in how much trauma our feet experience. Every step can cause a small amount of damage to a particular area in the foot which can increase the risk of bursitis.
• Morton's neuroma - This condition usually causes burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. You may sometimes feel that you are "walking on a marble," and you have persistent pain in the ball of your foot. You may also have numbness in the toes.
• Metatarsalgia - This condition can also cause pain in the ball of your foot, that area between your arch and the toes. Metatarsalgia is a common over-use injury, persistent stress can lead to chronic irritation and inflammation of the bone covering and surrounding tissues, such as ligaments and tendons.
• Plantar Fasciitis - Pain associated with plantar fasciitis normally starts as a dull ache and then progresses to a sharp, knife-like pain or constant throbbing feeling that is worse when you put weight on your foot. The most tender areas tend to be in the center of your heel and along the inside and bottom of your foot towards your toes, where your heel and arch meet.
• Turf toe - This can happen when the big toe joint is pushed beyond its' normal range (backwards or downwards). A 'pop' is felt at the moment the injury happens followed by sharp immediate pain. Symptoms include swelling in the foot, the entire big toe joint is affected and limits the motion in the toe.

My book covers remedies to help every single one of these problems. It details the most comprehensive list of modalities available today. I have documented my experience with most of them and give you accurate and up to date information on what works and what doesn't. I have seen some of the best doctors in the nation and present to you all of the accumulated knowledge I have gained over 2 years worth of trial and error.