The human foot is made up of 26 bones, and if you include the sesamoids, each foot actually has 28 bones. The sesamoids are tiny little bones under the 1st Metatarsal head, which sit on the bottom of the foot. The sesamoids are about the size of a chickpea (garbanzo bean). And, like the chickpea, the sesamoid has a groove on each bone to allow for the FHB (Flexor Hallucis Brevis) Tendon to easily glide over the 1st Metatarsal head. This easy gliding motion makes for a very efficient tendon, and it also provides for a fulcrum over which the tendon runs, like a pulley system. This pulley system is essential for the big toe, so that the tendon won’t tire easily.
There are many causes for sesamoiditis, including high impact activities that can lead to painful sesamoiditis; shoe gear, and genetics which can play a big role. Prevention, which involves wearing the right shoes, is key to avoiding sesamoiditis all together; however, once sesamoiditis has been diagnosed, it is equally important to find the best shoes for sesamoiditis.
Sesamoiditis is actually the inflammation of the entire Sesamoid-Tendon complex. Not only do the sesamoids themselves get inflamed, but the FHB tendon and the associated ligaments surrounding the sesamoids are also inflamed. There is a ligament called the inter-sesamoidal ligament which connects the two sesamoids together. Often with a sesamoid injury, this intersesamoidal ligament either ruptures or is torn or injured.
Non-surgical treatment options are recommended for Sesamoiditis without a fracture involvement. Rest, Ice, and Shoes are conservative treatment options. One other non-surgical treatment option is orthotics, or custom molded inserts, which go into your shoes and help to shift the weight from the sesamoids to the other metatarsal heads.
A custom orthotic with a “reverse Morton’s Extension” is essential. The reverse Morton’s Extension will put more pressure on the other metatarsals, and less pressure on the 1st MT head and the sesamoids. The orthotic should also conform to the entire bottom of the foot; this is important so that the weight gets distributed evenly across the bottom of the foot.
Although not common, sesamoid fractures do occur. It is important to have an XRay done to rule out a sesamoid fracture. If there is a fracture, it can heal with just rest and immobilization. However there are instances when the fracture will not heal. When that happens, it is called a non-union and can be very painful. A non-union can be treated with surgical removal of the sesamoid, which has had good results, alleviating pain with only minimal complications.
What to Look for in Shoes to Help with Sesamoiditis
While looking for shoes, make sure that you go shopping at the end of the day, as your feet will swell slightly by the end of the day, and this will affect your shoe size.
1. The best shoes for sesamoiditis are ones which do not bend much at the Metatarsal area, or the forefoot. If the shoes do bend at the forefoot, this will exacerbate the pain in the Sesamoid-Tendon complex, creating more pain and inflammation.
2. Make sure the shoe that you choose has a wide toe box. This wide toe box will ensure more room at the toes, helping to limit pressure on the sesamoids, which will decrease inflammation.
3. Shoes which have a “zero heel to toe drop” is important, so as to allow the heel and the ball of the foot to be on the same plane. This will allow the arch of the foot to take on more pressure, distributing the pressure evenly to the entire foot.
4. The shoe should be light weight, and have increased shock absorption, and cushioning. The shoe should also be deep enough so that it can accommodate a custom orthotic.
5. Be sure to stay away from heels. Heels will increase pressure on the 1st metatarsal head, and will shift the entire body weight on to the front of your foot, increasing the sesamoid pain. For women, especially, this can be a hard task to find a good dress shoe, that is also a comfortable shoe for sesamoiditis. The Clark’s Women’s Wave Cruise, Mary Jane dress shoe maybe a good option to accommodate the sesamoiditis pain. Although, this shoe has a very small heel to toe drop, it still has good cushioning, and a rubber sole, making it a good option for a women’s dress shoe for sesamoiditis.
The Best Athletic Shoes for Sesamoiditis
Here are some of the best athletic shoes to choose from:
This running shoe has a rubber outsole and an EVA Core heel, providing for increased shock absorption and cushioning. The New Balance shoes are also deep, and can accommodate for orthotics. The men’s New Balance is a good running shoe for sesamoiditis. The women’s version of the same shoe has a 12mm heel to toe drop, which may not be ideal for sesamoiditis.
This trail running shoe has a zero heel to toe drop, ideal for sesamoiditis, as it decreases the pressure placed on the 1st Metatarsal head and the sesamoid complex. There is also extra toe and heel cushion incorporated into the shoe. This shoe is one of the best women’s sneakers for sesamoiditis.
This running shoe is made from all synthetic material, and therefore, it is a vegan shoe. It has forefoot cushioning, a midfoot wrap, and an infinity wave bounce back heel. It also has a removable insole, so custom molded insoles can be used.
The Women’s Mizuno Wave Creation 17 Running Shoe is just as good.
This barefoot cross trainer has a zero heel to toe drop. However, since it is a barefoot shoe, it also does not have much cushioning and will not accommodate orthotics. This is best for sesamoiditis pain which is just starting. This shoe will alleviate the pain on the sesamoids, because of its zero heel to toe drop, however it has only a rubber outsole for cushioning and will not be good for sesamoiditis which has progressed and is already very painful.
5. Altra AFM1739F Men's Paradigm 3 Road Running Shoe and the Altra Women's Paradigm 1.5 Running Shoe
This is good running shoe for both men and women who have sesamoiditis. This shoe has a zero heel to toe drop, as well as plenty of cushioning with dual layer EVA, as well as shock absorptive outsole.
The best shoes for Sesamoiditis overall are the Altra AFM1739F Paradigm 3 Road Running Shoe for Men and the Altra Women’s Paradigm 1.5 Running Shoe for Women. They both have the zero heel to toe drop, as well as cushioning, and shock absorption. And, they have a sole that is not too flexible at the forefoot, and can accommodate orthotics.
If you do feel like you have pain in your big toe, especially when you move it up and down, you may have sesamoiditis. It is important to have your foot examined, to determine if you have sesamoiditis, and to make sure you do not have a sesamoid fracture.
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