You were also ramping up for your longest race....did you run more miles?

Got your PM ;
A common injury. There is a fine line between sesamoiditis, a sesamoid fracture or a bipartite sesamoid. Either way, yes, racing flats or "Pose" running transitioning can lead to this.

However, people in "regular" running shoes also get sub sesamoid/1st MPJ pain. If all other things are fine (i.e. no 1st met elevatus, significant forefoot varus, direct trauma to the area, etc., then can chalk it up to a training injury and/or the shoes. The A2 does actually have a decent amount of forefoot cushioning.

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Carlos- a true fracture of the sesamoid, one of two little bones under the ball of your big toe, frequently occurs following pretty significant trauma such as a fall. Like most of the other bones in the foot, they can also be subject to a stress fracture (see my blogs 4/25/09 and 10/4/09 about stress fractures) when given the correct (incorrect?) stimulus. And, for completeness, occasionally the sesamoid is formed in two parts, the so-called bipartite sesamoid. It's frequently in both feet. If plain xrays are negative, if there's a high enough "index of suspicion" a further radiologic exam may be in order like a bone scan or MRI. I know that ST'ers push for MRI's but insurance companies will commonly push back for the less expensive bone scan.

If you have a true fracture, immobilization and a period of diminished weight bearing will required. In other words no running (and frequently no biking so you'll have to do your exercise running in the pool. I have a blog on that, too, last month.) The shoes may be a contributing factor but I'd examine my training log for an overly aggressive running program. You should also ask this question of your health care giver. Good luck.

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Hi Carlos, Let me relate a similar experience I had - of course every case is different...

I suffer from acute pain in my great toe joint from time to time. At one time I had it really bad and went to see my doctor. My doctor took x-rays and though that I may have broken the sesamoid, but said that there was NO sign of arthritus. She referred me to a Bone and Joint specialist, they said that the sesamoid was fine but I had arthritus! They gave me a shank for my shoe and wanted me to immobalize my foot for 4 weeks.

After 4 weeks my foot felt even worse than before. Also my tendons had shortened up and weakened making walking painful.

My Wife gave me the advice that all these educated people missed - GET NEW SHOES - within a week I was running pain free!

Since then i have found that I run better in the Mizuno Wave Rider 12's and since switching to this shoe my toe pain is gone [12 months now]. I used to run in the ASICS 2130's.

I would say get a second opinion - preferably from a doctor who is also an athlete...and change your shoes to something with a little more cushion.

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Cheers...

Rich

Carlos,
Your injury might have been avoided by training if you had been training in your normal training shoes. If you have indeed fractured it, I hope that bone spurs do not develop on the damage bone.
I speak from experience. On a whim I decided to training in racing/training flats with only half of an outsole to the shoe. Well, running on the shoulder of the road I stepped on a large rock and damaged my inner sesamoid on my left foot. Had there been some hard rubber outsole it might have been protected better. The rock left a nice dimple in the shoe's midsole that was exposed.
2 surgeries (1 from misdiagnosis) later, I can run but had to have the bone removed due to calcium build up around the sesamoid. My left foot has nerve damage nonetheless and isn't as flexible.
All I can say is protect the feet. Before my injury, I was running mid 17 5k's. Because of the time off from 98-2005, am significantly slower (high 19's). I am in the game at least and recommend you protect the feet. I wish I had.
Hope this helps,
Paul

Paul, you raise an interesting point...given how easily you can damage your foot, the prospect of a long recovery and bone spurs etc, etc.

I have to ask, How wise is it for people to run barefoot??? OR- how wise is it to force mid or forefoot running??? OR - Newtons???

Mob metality and the latest fashion trends tend to draw folks in until the first casualties come marching in - sometimes you just have to wonder WTF are they thinking...

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Cheers...

Rich

Rich,
You live and ya learn. I wouldn't be doing sprint Tri's if it weren't for my bad running habits from when younger. In addition to having a bum foot, I over strided for years and did some damage to my knees. I almost gave up on running all together but a buddy suggested I start Chi Running fall 2008. Chi Running promotes landing midfoot/forefoot. Well I ran all last year without incident. Believe me, the moment I don't run this way, my knees let me know real quick. Another reason I am slower but hey, at least I am in the game still. Barefoot running is just nuts....
Later,
Paul

Thanks for all your replies.

It's been almost a month since my last run. Yesterday I ran 5 minutes on the treadmill and no significant pain. I'm waiting for the orthotics to arrive, then I will feel comfortable to run outside.

I've been reading about Joe Friel cleat position article and I really think this cleat position will help to relieve the pressure on the area.

Happy holidays...!



Carlos