I have a question about a pain in my foot. It first developed in mid-June and has ached off and on since then. Oddly, the aching does not correspond with my training volume. For example, my foot ached very little in late-July/early-August, when I was ramping up for my first 1/2 Ironman. Right now, however, I have been exercising *maybe *three hours/week and have not been running for almost a month, and my foot is starting to hurt like hell.
So a description of the foot ache: I have this ache/pain on the inside of the ball of my right foot. I believe this is called the “medial” side of the foot. After researching online, I believe the pain to be located very close to, if not at the location of, the sesamoid bones. When running and walking, the pain occurs when my foot rolls off the forefoot and onto the ball of the toe. There is no pain whatsoever when there is no weight applied to my feet.
I am a pretty significant over-pronator, so my running style doesn’t help this ache. I purchased custom orthotics and motion control shoes with medial posts in August after my 1/2 IM to try to help out the pain, but no luck. Like I said before, I haven’t run in almost a month, and I have been icing it and taking ibuprofen every day. Some days it simply hurts like hell to walk, other days it feels 95% fine.
Any medical advice or similar experiences out there? Thanks in advance!
Sounds like sesamoiditis, but this shouldn’t last this long and the on/off thing is a little odd. They do track around the crista on the bottom of the 1st met head and could be an occasional “tracking” problem. Also, the sesamoids are invested in the extensor hallucis longus tendon and a distal tendonitis can mimick those symptoms.
Try to curl/flex your big toe against some resistance (like you thumb). Does the pain stay localized or radiate down your foot? Have you had a simple X-ray of the area? A lot of people are born with a bipartite or “split” sesamoid (either the tibial or fibular one) and the 2 smaller bones are much more prone to mechanical irritation. I often have to remove one or both of the pieces (I have even done one such surg on a well known, but will remain un-named, professional football player) when all else fails.
Thanks for your helpful reply. As to your question – there is scarcely any notice of pain at all when I curl my toes against my thumb. The slightest notice of pain is localized – it does not move “up” the medial side of the foot towards the first metatarsal head, and does not move “down” the foot toward the arch.
I have seen a physical trainer and she, too, thinks it is sesamoiditis. At first she thought it may have been metatarsalgia, but there’s not any pain in the metatarsal heads, only the sesamoid. I have not had an X-ray done – I am at school in Virginia taking final exams and will be home in Michigan for the holidays, where I will get an X-ray on December 28 (earliest I could get!).
Had/have it. Try this. Get some good closed cell foam insoles for your shoes (the green kind with black foam–can’t remember the brand–but not Dr. Scholls). Cut a round hole in the one for the foot that hurts right under the big toe joint. This will relieve the pressure on the joint when you run and walk. Wear them all the time–do not run around barefoot.
Avoid going barefoot. Pad the area as best you can. Ice the area too. You sound young, so I’m betting a bipartite tibial sesamoid is in your future. That does not necessarily mean surgery, as sesamoiditis almost always calms down - problem is, it will continue to be prone to repititive injury, especially in a runner/cyclist.
Avoid going barefoot. Pad the area as best you can. Ice the area too. You sound young, so I’m betting a bipartite tibial sesamoid is in your future. That does not necessarily mean surgery, as sesamoiditis almost always calms down - problem is, it will continue to be prone to repititive injury, especially in a runner/cyclist.
Best of luck to you -
Will do re: barefoot. That makes sense – wearing shoes = more padding = less irritation of the sesamoid.
I am indeed young, 20 years old, this is my second year of triathlon. Played basketball and golf since I was ~10 and never had any foot problems like this (of course, had some sprained ankles in hoops, but no forefoot problems).
“Bipartite tibial sesamoid” – what is that? Two of something evidently… :-o If you could clarify that’d be terrific. I’ll pass the info on to the doctor in my family and see what she has to say (Mom’s a radiologist).
Thanks rroof, look forward to any follow-up on this you might have!
bipartite sesamoid simply means the sesamoid is in 2 separate pieces (either sesamoid or both can be). It is also usually bilateral (on both feet). It is a fairly common congenital anomaly and in of itself is not a problem. Again, the 2 separate pieces (often misdiagnosed as a fracture by the way) are more easily mechanically irritated. You basically just need to take extra precautions to not irritate them. Your new sport of choice is obviously particularly hard on the ball of the foot. Lastly, it can be removed without any long term sequelae as well.
I don’t want to contradict rroof here, I know he is a specialist–but, in my experience, don’t pad directly under the big toe joint. That will actually put more pressure on the sesamoid. Pad AROUND the joint to take the pressure off the area. The brand of insoles I was thinking of is “Spenco.” Get a pair of those and stand on the one for the foot that hurts. Trace aroung your big toe joint (kind of hard to do) and then cut a hole about the size of a nickel to a quarter out of the insole. If need be you can build up the area aroung that hole by putting a “C” or “L” shaped piece of molefoam on the bottom of the insole so that even more pressure is taken off your sesamoid.
Don’t look for a complete cure. I have had it for years, and even though it is much better, I still wear the insole. My podiatrist gave me some ultrasound treatments, and that also helped a little.
