When A Runner With High Arches Has Increasingly Painful Sesamoiditis

A patient contacted me with an “extremely worrisome” case of sesamoiditis for more than two years that seems to be getting a bit worse. Over the course of the past two years, the patient continued to run on the foot because she did not want to stop, but the injury would flare up. She would go through periods of time when she wouldn't run because of the pain and is currently taking another break from running.

A different podiatrist gave the patient 3/4 length orthotics with dancer pads attached to take the pressure off the ball of her foot but this was not 100 percent effective, according to the patient. The patient has also been going to physical therapy but her injury is not going away. She has high arches and due to the patient’s biomechanics, her feet have a tendency to lean inward, putting more pressure onto the ball of her foot. The patient has sesamoiditis in both feet and it is worse on the left side.

I do find that high arched feet are the hardest to address with the current technology. Sometimes you have to consider a full-length Hannaford type insert, which works well.

Although no healthcare provider has recommended cortisone shots for this patient, the patient has an eating disorder and fears weight gain if a doctor recommends cortisone. Having a limited ability to exercise has also made it difficult for this patient’s eating problems and she notes she must walk several miles every day to her college classes. “I fear that there is no end to this injury and I will have horrible problems functioning in daily life,” the patient says.

Any bone injury needs the right nutrients to heal so this patient’s eating disorder may be the issue. I have encouraged the patient to seek out the advice of a nutritionist to help attain the minimum of bone density and vitamin D3 levels.

The patient also wonders if the condition is a sesamoid fracture as opposed to sesamoiditis. To determine this, clinicians should order a magnetic resonance image (MRI).

In regard to how long this patient should wear orthotics or dancer pads, there are many individual factors that clinicians should consider. Is there functional hallux limitus? Is there a long first metatarsal? Is there a plantarflexed first metatarsal? What are the demands of that activity? To summarize, we want to protect the patient’s remaining sesamoid but need to use common sense. 

The patient notes the orthotics do not even provide relief in regular athletic shoes and only work in a certain pair of fashion sneakers. If the patient is limited in what shoes she can wear at work, what does she do about her professional career? Does she bring in a doctor's note saying she has a medical condition that limits which shoes she can wear?

If she were to get surgery, would the patient be able to resume running again? This would be up to the treating doctor. Hopefully, a simple dancer pad will suffice in most shoes. Surgery can be very successful but we are trying to avoid surgery in cases like this. The goal of that surgery is to allow full activity again. It sounds like this patient needs better orthotics and needs to get an MRI.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2016/09/sesamoiditis-vs-sesamoid-fracture-email.html . It is reprinted with permission from the author.