I've been waiting a long time to post something about my experience with the little-known but very debilitating foot condition called Sesamoiditis. If you need no introduction to sesamoiditis then chances are you have been diagnosed with it, either in the past or currently. If you've had it you know how pesky and frustrating and downright depressing it can be, especially for a runner. Because the general population is usually unfamiliar with the problem and in fact, has never heard of sesamoid bones (I know I hadn't!) I'm going to introduce the condition. After that, I'd like to speak about my experience with it and how I've been able to manage the pain and get back to running.
First things first: what is sesamoiditis? The sesamoid bones are located in several areas of the body, but for our purposes (see: runners' purposes) I'm going to talk only about the sesamoids located under the ball of the big toe. I'd suggest doing a quick google search of the sesamoids to get a good illustration of where, exactly, they are located. But basically, there are two "floating" bones embedded in the tendon of your foot that runs through to your big toe. The sesamoids and tendons together form a kind of pulley system that gives your big toe its action and your foot balance. Long story short: the sesamoids are an important part of the physiology of your foot (and your body, in general).
The problem is, when those little sesamoid bones become damaged in some way, usually through over-use or a foot-related injury, they cause BIG problems. Your sesamoid bones absorb a lot of your body weight while you are walking and running, so you can imagine how hard those little guys work and the kind of wear-and-tear they accumulate. There are several ways to damage a sesamoid bone, so if you believe you have a problem related to your sesamoids, always consult with a podiatrist. Sometimes your sesamoids can fracture due to impact, let's say walking barefoot on a stone. Other times, your sesamoid can simply become inflamed, usually from over-use. My experience deals with the latter.
Sesamoiditis symptoms. To put it simply, ouch. One day you suddenly feel discomfort walking how you normally would. The pain can start off dull, or acute. Either way, the pain doesn't go away when you wake up the next day. Pretty soon you find that you can barely put weight on the affected foot and naturally transfer your weight to the outside of the foot, changing your gait accordingly. A week goes by and hopefully you've made a call into the foot doctor to have it looked at. And hopefully you find a good doctor. He or she will tell you that you have sesamoiditis (what's that!?) and will suggest a couple different recovery approaches. He or she will, at the very least, take an X-ray and send you home with one of those foam pads with a hole cut out of the big toe in order to transfer the weight off of the affected area. Recovery time can be weeks or months. Or in my case, years.
Okay, so I'll give you my story. But first I want to say one more thing about sesamoiditis. One thing I learned about the condition is that it's not that your sesamoid bones are broken, necessarily. Although, that could very well be the case, so again ALWAYS GO TO A DOCTOR. How it was described to me is that the bones themselves could have been bruised for a time, but that they eventually heal. Bones heal pretty quickly. Tendons, however, have a habit of going a little haywire from time to time. And when you combine the low circulation of the foot with weirdo tendons, you get a tendon that *thinks* it's injured and therefore acts like it's injured, i.e. HURTS. The tendons are telling your brain to tell you that they are damaged and need to be treated as such. The body's ingenious way of sending that message is through pain. That's where my sesamoiditis comes into the picture.
So, my story...
In January, 2017 I attend a march in downtown Los Angeles. I noticed after the march, probably the next day that my foot began to hurt under the ball of my left big toe. I ignored the pain and went to work, wearing the same shoes I've always worn (I'll get into that later) and going about my business. But the pain didn't go away. Days after, the pain got worse and I found that I actually began limping. I honestly can't remember if I was even running at the time, I believe I was too busy with other things - but the pain was there even while just putzing around. So I made an appointment with a podiatrist.
The podiatrist X-rayed my foot and told me no bones were broken. He then introduced me to the term sesamoiditis, a term I found so incomprehensible that I had to call back in the next day and ask to have it repeated. Se-sa-moid-it-is, okay. During the visit he gave me a cortisone injection between my toes (ouch!) and a cheap foam insole with a hole cut out of the big toe, in order to keep that area from being impacted while walking. He told me to wear my running sneaks for a while, which I did. Almost immediately, my foot felt better and after about a week or two, I went back to wearing my regular shoes.
My regular shoes were bad. Very, very bad. I was wearing Clark's desert boots. I remember the guy who fitted me for those at the Clark's shoe store even suggested that I go a size down so they "fit better". That was a huge, huge mistake. So anyway, I threw back on my old, worn out, Clark's desert boots I've been wearing for over a year and got on with my life. Several months went by before the sleeping beast returned and this time, it was no longer just a nuisance, it was debilitation. I can't pinpoint exactly when the pain came back but I do remember that at first it felt like a rock was in my shoe. I also remember that I went running with the pain the next day. Another BIG mistake.
Weeks went by and the pain got much, much worse. I made another big mistake during that time by not going back to the podiatrist. I guess I figured that I'd already been there and I knew what the problem was, so all I had to do was wait it out. I did do one right thing which was I GOT RID OF MY BAD SHOES. My boots looked good but the soles were worn out and they were a size too small (in fact, I think two sizes!). The physiology of one's foot demands that we have sufficient room in the toe-box of the shoe. That means we have to be fitted correctly and pick a shoe that has enough toe room.
My sesamoiditis came back with such a vengeance that at one point I actually purchased crutches and a medical boot to keep the affected foot from bearing any weight at all. Did it work? No. The pain returned even while just walking around the house and in any footwear other than my medical boot. I may have been taking some of the pressure off during the day but the sesamoiditis was not healing. I tried a variety of remedies during this time that I found online, such as hot-and-cold foot baths, some massage techniques, a compression sock and you-name-it. None of it worked. At first, probably due to wishful thinking, I was convinced that these treatments were helping but at the end of the day, they just weren't. One thing that did seem to help at least to keep me on my feet was getting a pair of Crocs and putting in that insole with the toe cut out from my first podiatrist visit.
But it wasn't enough, because I still had to wear that big ugly surgery boot and I certainly couldn't get back to my running. Almost a year had gone by at this point and my foot was worse than ever. So finally at the point of utter desperation I made another appointment, this time with a different podiatrist. The thing I liked about my second doctor was that he was against cortisone shots. Not against, per se, but cautious. He told me instead that we'd get some custom insoles (not the cheap, foam kind) and see how they worked for a couple months. Yes, months. At this point months seemed like days, since I'd been living with this pain for over a year.
The insoles worked like A CHARM. In fact, as soon as I got them I was able to wear a normal pair of shoes again. After I got rid of my old, worn out boots I bought another pair of boots (I like boots) that were the CORRECT SIZE (very important) and had big, stiff soles. These were actually perfect for me and the insoles fit perfectly inside of them. So I was a happy camper. A couple months went by and my pain, although it was still certainly there, was much, much better. One problem though: when I threw on my running shoes and went for even a mild jog, the pain came raging back. Ouch!
Okay, so now back to the podiatrist, this time for another cortisone shot. I figured, hey, it really helped the first time so I'll try it again and maybe my pain will just magically disappear. And now that I have my custom insoles, the combination could do the trick. After we had a convo about it, he gave me the injection and it seemed to help. But not for long. It actually didn't really do much the second time around. The pain was pretty much back to where it was when I got the insoles – not debilitating – but still keeping me from running. I felt pretty defeated.
Fast forward to June 2018 (yes, one and a half years!) and my sesamoiditis has basically plateaued. I did take a couple runs that didn't end with severe pain but the condition was still keeping me from running on a consistent basis and without having to change my gait to compensate for the pain. But since so much time had gone by and because I figured that there wasn't much to lose, I decided to try seriously running again. This time, I decided to try changing my running shoes, not just my street shoes. What I wanted was a REALLY cushiony shoe that could basically absorb most of the impact of running on my affected foot. The shoes that I ended up trying on after much online research were Hokas. I believe there are other shoe companies that offer the same kind of cushion and structure and I haven't tried them all but Hoka One Clifton 4's fit the bill. They were extremely cushiony but also had the right amount of spring in the sole that kept my momentum going while running. They felt good after a quick jog outside of the store so I put down my money and hoped for the best.
Today I am happy to report that I run almost daily. It's only been a couple of weeks since I started up again but I can tell that the combination of my custom insoles and these shoes have saved my foot. And the even more fortunate thing is that since I've begun running I feel that my affected foot has been getting steadily stronger which helps the pain. My sesamoiditis pain isn't 100% gone and may never completely go away but at least now I can be as active as I was before I was diagnosed. And I can't tell you how overjoyed I am to be back to running after a long 1.5 years.
So that's my story! Below I'm going to give a list of advice that basically boils down the steps I *would* have taken if I could rewind time. But that's life, right? I wouldn't have learned this stuff without, well... learning it!
Some advice for those suffering from sesamoiditis:
- First of all, SEE A PODIATRIST. This is absolutely the most important step. At the first sign of what might be sesamoiditis go to a doctor. The earlier you begin to treat it the better. One day will turn to one week, one week one month and one week one year. Try to keep that from happening. Also, if you see a doctor and find out your sesamoid bones are fractured DISREGARD ALL OF MY ADVICE. That was not the boat I was in. I was in the "inexplicable sesamoid pain due to overuse" boat.
- Talk seriously about getting a cortisone injection with your doctor, don't just let him/her do it. I'm not saying you *shouldn't* get a cortisone shot, I'm just saying that in some cases it's not entirely necessary. Unless the pain is so debilitating that you literally cannot walk, I would muster up some patience and let your injury heal with less invasive treatment.
- Which brings me to my next piece of advice: GET CUSTOM INSOLES. There are insole skeptics that say they don't really do much and are just a way for doctors to make an extra few hundred bucks, but in my experience they were a LIFE SAVER. Especially combined with my custom insoles.
- This one should be obvious but when you first begin to feel sesamoiditis pain (or any foot pain for that matter!) STOP RUNNING. It's not good for your foot and no, you cannot "run pain away". It will only make matters worse. I swam a lot during my 1.5 years of sesamoiditis pain and that kept me healthy. Not the same as running though!
- Everyday shoe wear. This is just as important as insoles. Get a good pair of everyday shoes with a sturdy sole. Sometimes people think that a soft-soled pair of comfortable running shoes would be good for the injury (I know I did!) but this is just not the case. The new pair of boots I got after I threw my old, worn out and undersized pair away was a new pair of boots with a good, sturdy crepe sole. They were also the right size, which is kind of a no-brainer but worth mentioning. GET YOUR FEET MEASURED.
- At-home shoe wear. One thing I haven't mentioned yet is that when you have sesamoiditis you should NEVER WALK BAREFOOT. I mean, I guess you can walk barefoot on the beach but other than that avoid it at all costs. I got a pair of Crocs with a foam insole with a hole cut out in the ball of the big toe on my affected foot.
- Running shoe wear. This is really the kicker. Because, first of all, you shouldn't be running when you first get sesamoiditis. So be patient. That's number one. However, although it might sound contradictory, never putting pressure on your foot I think is just as bad. That's why I believe running again is actually helping me heal the foot (after a long 1.5 years of staying off of it!). What I would suggest is finding a perfect pair of running shoes that babies your foot. That's why I picked Hokas. Hokas aren't the coolest looking running shoes out there and they kind of toe the line between sport wear and like, nurse's shoes but that's what makes them so great. Running is not about vanity, it's about health and happiness. So base your selection only on those factors. Hoka One Clifton 4 is what I ended up choosing because they had the right amount of cushion and bounce (very important for the recovery phase of your stride).
- And that's about it. Insoles, stiff-soled everyday shoes, at-home sandals (Crocs in my case) and a good, supportive running shoe. Some might suggest hot-cold baths and other wizardry but I had no luck with that stuff. I'm not saying don't try it but don't get frustrated if it doesn't work.
Above all, it's about patience and persistence. It's better to recovery over a period of 6 months than create more problems. Stay off your feet for the first month and then gradually test the waters. Make sure to get back to running and exercising your foot in a way that builds muscle but make sure not to impact the affected area too much. That's where proper footwear comes into play. Please give feedback! I'd like to know if anyone's reading this and if you have had any similar (or dissimilar) experiences!
Likewise, I have dealt with senamoiditis, which is a semi-rare occurrence in runners, but potentially career ending. You end up with a stress fx of the sesamoid, and you are pretty much done as a runner.
However, mine has really only taken a few days or weeks here or there of management. Get some dancers pads and throw them in your running shoe on the affected foot. I was able to cut mileage and run through it without any pain doing that while it healed. But yes, I agree on the stiff-soled soles (Birkenstocks with sesamoid pads in them were great). I found walking actually more painful than running because of the heel-toe motion of walking. I'm a mid foot striker when I run, so that was less painful.
My doc, however, strongly recommended against cortisone - you risk weakening that bone, and it's a high risk area for a fracture. Fractured sesamoids easily lead to necrosis and potential removal, and then you DEFINITELY aren't running again.