How to Heal Sesamoiditis, the Peskiest Injury Known to Man

There is nothing, NOTHING, more demoralizing as a runner than having an injury that will not heal, regardless of how many hours you put into sitting at the doctor’s office, researching treatments, and implementing those treatments flawlessly. I was a math major in college, and the most frustrating thing in the world is when things cannot be explained with logic and reason.

Logically, if you’re icing, resting, compressing, and eating a healthy, anti-inflammatory diet, there is absolutely no logical or reasonable explanation for why an injury is taking weeks, months, or even years longer than expected to heal. Doctors, who study science for years and are supposed to be experts in logic and reason, often just shrug their shoulders. There are often no alternative avenues, after you’ve exhausted all the logical and reasonable options. And that is bullshit.

I have been lucky with injuries, especially as someone who has been running for over 12 years straight. The only injury I ever had before 2015 was a stress fracture in my metatarsal, which healed quickly and painlessly after four weeks in a boot. I must be fucking superwoman, I had thought then. I heal so fast. Wolverine, but less hairy.

Yeah, sure. Everyone heals quickly when they’re 19 years old. It’s when you start creeping into your mid-20s that things get a little less easy peasy lemon squeezy.

My first post-fracture injury was a sesamoid injury, one of the most obscure injuries known to man. No one I talked to even knew what or where the sesamoid bones are (and neither did I). There seemed to not be a whole lot online detailing how to treat a sesamoid injury.

Basically: sesamoiditis is inflammation of the two tiny sesamoid bones that are in the ball of your foot, which act as part of the big toe joint. Having sesamoiditis means having pain whenever you step down on the ball of your foot, and it could also mean difficulty bending your big toe. For such tiny bones, they can definitely cause a lot of pain and a HECK of a lot of heartache. If you are reading this, you probably already know all about it, and are here for some answers, not really to hear me talk about myself.

Well too bad. Disclaimer: I AM NOT A DOCTOR. I am a data analyst, on a contract with the USA government, and I am a lazy one at that. I do not know anything beyond what my own experience with sesamoiditis taught me, so yes, this post is about me and my journey, and no, I cannot give you any medical advice when it comes to healing your own sesamoid issues. This is just about what worked for me, and I have been sesamoid-pain-free for almost two years now. And you can be too, I know you can.

How I first contracted this bullshit injury

When I was one year out of college, I moved from my home in blazing hot, conservative Arizona to Washington DC to start a life a little bit closer to family. It was a move from the suburbs to the big city, and I parked myself alongside my best friend from college in a dark, dank basement in the heart of the city.

The first few months were amazing. We were living it up: visiting a hip new restaurant every week, drinking wine together after work, and generally enjoying all the things that DC has to offer.

I should have known it was too good to be true.

In December, I went to my first meet-up of the DC Capital Striders, DC’s running group. It was a lovely 8 mile run from Dupont Circle and along the Potomac River, and I met some new running friends who I was excited to get to know better in the coming months. As I was walking home, I noticed a sharp pain in the ball of my left foot. I shrugged it off and went about my day, continuing to run over the next week, but by that weekend, I knew something was really wrong.

Turns out, you can’t wear flats or heels to work and walk several miles a day in them on the hard concrete sidewalks of DC without some sort of repercussions. You can’t refrain from stretching after runs because it’s boring and you really don’t feel like it. I was doing all of those things. Of course.

After a bunch of Internet research, I was pretty positive that it was sesamoiditis, the most mysterious injury on the interwebs, and my podiatrist quickly confirmed it, though he had no real idea of how to get me back on my feet, so to speak. And so launched my four-month-long journey of trying every treatment under the sun.

What I tried that did not work…at all

A boot.

Jesus have mercy. After wearing a gigantic, bulky boot all the way up to my knee for two teeny, tiny bones in the ball of my foot for an entire month, I realized that I had done absolutely nothing but atrophy my calf muscle and inflame the bone even more, if that is possible. I had gone from some pain when stepping down onto my foot to feeling as though I had a balloon full of pins and needles under my sole. Leave the boot to immobilization for bone breaks, because it did very little to help with my inflammation. I have heard similar grievances from other sesamoiditis sufferers with incompetent doctors.

Zero-drop shoes.

Okay, so it is not ENTIRELY true that these were completely unhelpful. After hearing some other peoples’ stories, I decided to invest in a pair of Altra Intuition 4 running shoes

, which have a freakishly wide toe box and a heel at the same height as the ball. Hence zero drop. They are good in theory because it makes it so that the ball of your foot is not bearing all of your weight, which is what we want. Additionally, according to one of the many aloof doctors that I went to see, my foot was in the beginning stages of a bunion formation, meaning I was wearing too many shoes that made my toes all scrunched together, which was contributing to the sesamoid pain. I’ve always known high heels were evil.

All those benefits provided by the Altras were good for my feet. To this day, my feet are super wide from wearing these for a couple months and allowing my toes to stretch out. Our feet were not meant to fit into pointed-toe shoes. It’s unnatural. However, the shoes eventually led to my second injury, tendonitis in my ankle, due to their lack of support. If you do decide to try these shoes out, just be sure you’re maintaining your regular stride and strength training to avoid further injury.

Ultrasound treatments.

I got this done at the physical therapist office, which was basically just 20 minutes of an ultrasound wand getting rubbed all over the ball of my foot to help draw blood into the area and kickstart the body’s natural healing process. Though the treatments definitely felt good and I got some immediate relief from them, after about six sessions I had no real improvement in my overall injury. So that was probably a waste of copay money.

Heat.

Hot baths feel good, but they did nothing to help with the inflammation.

Indefinite rest.

I cannot stress enough that the last thing you want to do when you’re injured is lay on the couch like a lumpy potato. The veins that lead into the balls of your foot are really small, and when the area is inflamed, even smaller, which restricts blood flow to the bones. Blood flow is smart, it is kind, it is important. And there definitely will be absolutely no blood flow if you’re just sitting around.

I am not saying go for a run, or do anything that involves a lot of impact to the front of your foot. You definitely want to stay off of it as much as possible. However, there are definitely things you can do to keep the blood moving and keep you from gaining a bunch of pudge. No one wants pudge, least of all your swollen feet which have to bear all your weight.

What I tried that finally did work

Prescription anti-inflammatories and KT tape.

This was the single most helpful combination of treatments in getting my sesamoiditis to say sayonara. Seriously, nothing worked like a charm until this. It was incredible. After four months of sobbing and whining and Googling, this very simple solution fixed my feet.

My doctor prescribed me a prescription anti-inflammatory, which I took for two weeks. It was stronger than ibuprofen alone, and allowed me to take the pills for a shorter amount of time than had I been self-medicating with ibuprofen. I also discovered my truest love in KT tape

. This tape can stay on for up to a week, and its purpose is three-fold: support the injury, reduce inflammation, and increase blood flow. The combination of the anti-inflammatories and the tape was enough to stop the inflammation, which freed up the veins a bit and allowed more blood to the area to heal.

Here is the video that shows you how to apply the tape to the ball of your foot.

Foot massage and stretching.

After months of visiting the physical therapist, I basically looked at him bleary-eyed and told him I was losing hope. The ultrasound treatments weren’t a big help, and nothing I was doing was working. I needed help, I needed a reason to go on. Without saying a word, he seized my foot and began digging his hard, man knuckles into the arch, right underneath the sesamoids, sending me reeling in the most intense pain I’d ever had. Seriously, fucking ouch. Turns out, my muscle there was incredibly tight, and him breaking them down a bit really took some of the pressure off my sesamoids.

On a related note, I also discovered, during my many months of desperate research, that the calf muscle and the sesamoids are all connected through the same system in your lower leg. Stretching your calves, and foam rolling them to keep them loose, is a really good way to not only provide instant relief, but also fix your stride. Tight calves leads to a narrower range of motion while walking, which makes you apply more pressure to your big toe as you push off. Keeping your muscles loose is just good advice in general for preventing or healing injuries.

Biking and swimming.

As a follow-up to my don’t rest indefinitely advice, biking and swimming are the two best things for you during this difficult time. I put my heel in a stationary bike in the gym and biked like that for 45 minutes a day. It got the blood flowing, and the exercise made me feel better emotionally, which is always important for healing. Nothing like some good ole depression to make your body hurt everywhere.

Custom orthotics.

These did cost me about $200, but having a cut-out at the ball of the foot to allow the sesamoid bones to float, reducing the impact on them when walking, was helpful. If that is not in your budget, opt for PediFix Pedi-gel Dancer’s Pads

The takeaways

, which stick to the bottom of your foot and essentially provide the same value for a fraction of the cost.

They say you learn the most from the most traumatic experiences. Not to be dramatic, but running injuries are the goddamn PITS. And yes, they can be traumatic, especially if you’re someone who is used to running every single day. Having the one thing you’re passionate about ripped away from you while you sit on the couch wasting away is horrifying, and I hope that this post can help at least one person who is currently struggling the way I did.

That being said, here is what four months with sesamoiditis taught me:

ALWAYS see a sports medicine doctor, not a podiatrist who is used to dealing with older, non-athletes. My podiatrist basically told me that he was baffled by my lack of progress after two months, and made me resign myself to never running again. If Olympic athletes can fall, twist their knee in half, rip all the tissue inside the joint, and be back running in six months, I knew that there had to be a way to overcome this. You just have to find someone who cares almost as much as you do.

Do not overcompensate. I was overcompensating for months, trying to keep the weight off the front of my foot, which contributed to injuring other parts of my foot and legs. It just isn’t worth it.

On that same vein, you MUST work on strengthening your body while you are injured. Keep your calves strong, even if you aren’t running. Keep your hips strong and loose. Do squats and build your glutes. If you don’t commit to this, you will ultimately reinjure yourself in the near future (believe me. I did).

Take healing seriously as well. This is a stubborn injury, and you have to commit 100% to getting better, both in your actions and in your thoughts, in order to overcome it.

Do not take movement for granted ever again. I certainly have not. You won’t stay young forever, so you have to take care of yourself at all times to get the most out of your body as you can.

Also don’t rush back into running. You need to reintroduce impact to your sesamoids very slowly to ensure that the injury doesn’t come back. Don’t put in a lot of hard work for nothing.

Remember that your life will go on, regardless of the injury. Try not to dwell too much. If you’re taking your recovery seriously, the end of the injury will come eventually. Suck it up and try to find happiness outside of running temporarily. There’s a lot of great things out there in the world that you shouldn’t miss out on just because you’re sad about a tiny foot bone.

If you’re reading this and struggling with sesamoiditis, feel free to reach out to me personally with any questions and concerns you have about your own injury. I know it blows and my heart is with you. If you have overcome sesamoiditis already, share your experience below!