Feet
> Sesamoid
Disorders > Treatments
Non-Operative
Treatments
Treatment Introduction
Sesamoid disorders, including
inflammation, sesamoiditis, or fractures, may be treated
symptomatically. This means your physician prescribes
enough support and rest so that you can walk around
without feeling pain. Everyone’s specific treatment
is slightly different, based on your pain tolerance
and your body’s natural ability to heal. In general,
a sesamoid disorder heals over the course of about six
weeks. A combination of the following non-surgical treatments
may be used to treat your sesamoid disorder:
Relative
rest – Decreasing the intensity and duration of
your activities can help decrease your pain. You may
need to stop running and switch to other aerobic activities
that are easier on your feet, such as swimming.
Decreased
heel height – Wearing shoes with lower heels than
you were wearing when the injury occurred can lessen
the strain on the ball of your foot.
Taping
– To decrease bending in your big toe, the simplest
taping method involves putting the middle of a strip
of athletic tape over the top of your big toe, just
below the toenail. The tape is wrapped around your toe,
crossing underneath the ball of your foot, with the
ends taped to the bottom of your midfoot. Physicians
generally recommend you visit a qualified athletic trainer
to have your toe taped.
Orthotic
shoe insert – A molded orthotic insert that adds
height to the outside of your foot can transfer some
of your body weight to the outside of your foot and
relieve stress under your big toe.
Cast
shoe – These open-toe sandals made of wooden or
hard plastic bottoms are designed so that your toes
do not bend when you walk.
Medication
– Anti-inflammatory medication can help ease the
pain.
Steroid
injection – Used sparingly, a steroid injection
can help ease pain and decrease swelling. Steroids are
not used when your sesamoid is fractured or cartilage
is damaged.
If your sesamoid has been fractured or if other conservative
treatments do not ease your pain, your foot may be immobilized
in a cast or brace.
A short leg walking cast wraps around
your foot, ankle, and lower leg. It starts below your
knee and is open around your toes to allow toe movement.
Short leg casts are made of layers of fiberglass. Your
physician usually rolls a thin, elastic stocking, called
a stockinette, over your skin. A dry layer of fiberglass
is wrapped around your leg and foot. Extra fiberglass
strips are wrapped around the sole of your foot. Additional
fiberglass layers are applied wet over the first layer.
Many patients receive pain relief
by wearing a brace called a cam walker. A cam walker
is a removable boot, made of nylon straps that fasten
around your calf and foot. Most cam walkers have an
adjustable hinge at the ankle that can be set to allow
the range of motion your physician prescribes. The sturdy
bottom of the cam walker is rocker shaped, which enables
you to walk without bending your toes. You typically
can walk around pain-free in a cam walker, but you should
avoid any strenuous activities or long duration walks.
You typically will wear the cast or cam walker for about
six weeks until you can return to normal shoe wear without
pain. If pain persists, the cam walker may need to be
worn for an extended period of time.
Take it easy on your foot until you
can walk in normal shoes without pain. This may take
about six weeks, depending on how fast your body heals
and how much damage was done to your sesamoid. Continue
wearing your cast shoe, cam walker, or short leg cast
as prescribed. Most patients return to their physician’s
office a few weeks after treatment begins for a check-up
and X-rays. Your cast may be removed after two weeks
and you may be put into a removable cam walker if you
need continued support as you begin walking. If the
pain goes away and your physician sees signs of healing
after six weeks, you typically can return to normal
shoe wear. When you can tolerate the pain, a period
of relative rest begins, which lasts until your foot
can withstand the stress of the activity that caused
the sesamoid disorder. Relative rest means that you
need to keep your activity level below your level prior
to injury. Though the pain has gone away from your foot,
you are still at risk for reinjury if you return to
the same activity that led to overuse and caused the
injury. In some cases, your pain may continue for a
prolonged period of time. After four to six months of
conservative treatment without results, you may become
a candidate for surgery to remove the injured sesamoid.
Formal physical therapy may not be
necessary after a sesamoid disorder. Many patients can
adequately restore motion and strength in their big
toe with a regular cardiovascular exercise program.
Most patients can return to sports and activities within
two or three months after the injury. Begin exercising
with short walks and increase the duration and intensity
as pain allows. You may be able to use stationary cycles
or swim without causing much pain in your foot about
two weeks after the injury, except when you are wearing
a cast. When your pain is gone, start with low impact
exercises. Progress to light jogging before sprinting,
jumping, and cutting. More vigorous running and exercise
typically can begin within eight weeks after treatment
begins. Gradually return to activities with pain as
your guide. Understand that your level of activity prior
to the injury was somewhere above your foot’s
threshold to withstand the forces and stress of that
activity. Increase your workouts slowly, and if pain
returns, decrease the intensity and duration of your
walks, runs, or other physical activities.
The best way to prevent reinjury in
your sesamoid is to be sure that your big toe is flexible
and strong before you begin repetitive running, jumping,
and cutting motions. The risk of reinjuring your sesamoid
is small if it heals properly. Returning to activities
before your pain has gone away and increasing your activity
level too quickly may cause pain and symptoms to flare
up again. Proper footwear, designed for your particular
sport or activity, can help protect your foot against
abnormal strain in your big toe joint. Avoid wearing
old, worn-out shoes when you are running or participating
in activities that pound your feet. In general, shoes
with higher heels put more strain on the ball of your
foot and should be avoided. Depending on the shape of
your foot, you may benefit from orthotic devices molded
to decrease the strain that passes through the ball
of your foot when you walk or run. Your physician typically
has these molded for you if necessary.
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