As podiatrists and high-heel experts we are often clinically treating women (and men!) with a debilitating forefoot condition that can literally stop you in your tracks and from wearing what you love best… high heels! The culprit is the sesamoid. The sesamoid is a small pea sized bone that sits on the underside the the 1st metatarsal (big toe joint). We have two of these and their function is to offload the forces from the big toe as we push off in gait. They are one of the most commonly injured areas of the foot in high heel wearers. So how to stop them from causing you pain?
First, a bit more background. To defeat your enemy you have to get to know him (ha!). The sesamoids are embedded in the flexor hallucis brevis tendon which sits under the big toe joint. They aid to improve leverage and protect the flexor hallucis longus tendon when plantarflexing and propelling body weight forward. No small feat for a bone so small!
Sesamoiditis occurs when the tissues surrounding the sesamoids get inflamed. This condition mostly occurs when there is repetitive trauma to the ball of the foot and is common to sports such as dancing and running. Which brings us to the topic of footwear – which shoe continually loads the forefoot for often hours on end? Anyone? That’s right our beloved heels. So, what do you do if you suspect you have sesamoiditis or even better, want to avoid it?
TWH tips for avoiding sesamoid injuries –
- Sesamoiditis often starts gradually with pain under the ball of the foot (near the big toe). So don’t wait for it to get worse – consult your podiatrist as soon as possible to get an accurate diagnosis and treatment plan.
- Lower your heel height immediately. Don’t wear anything higher than a midi heel and preferably a shoe with forefoot cushioning. A sports shoe is ideal here but if not appropriate for work, try wearing a wedged street shoe with a cushioned mid-sole. Isabel Marant anyone?
- Even if you don’t have pain, it helps to alternate higher heel days with lower-heeled one to give the sesamoids a break.
- Where possible, opt for styles with a thicker or cushioned forefoot platform
- Even better – wear your wedges a few times a week! Especially after a long day in pointed toe stilettos (Louboutin we’re looking at you)
- Stretch your calf muscles regularly – this will reduce pressure on the ball of your foot by giving your ankle joint more flexibility
- You may need off-loading with an insole or orthotic for a spell if you have sesamoiditis, or possibly longer term if you have a foot type such as a high-arched or flat foot. A good podiatrist can even make you a dress pair to fit into certain heel styles.
- DO NOT LEAVE IT! The sesamoid bones can fracture if repetitive stress continues which will mean a lengthy stay out of your favourite shoes!
So look after those little bones of yours. Your beloved shoe collection will thank you for it.
Until next time,
E & E
