Track and Field

       Southern California 

Medical Support Group

(310) 471-7401

Dr. Paul R. Copeskey, DC, CCFC

Sports Injury Specialist

The Orthotic Doctor

A reality in life is that feet gradually get flatter as we put thousands of miles yearly on them and most people average 200,000 miles in a lifetime.  My custom orthotics correct abnormal foot alignment and uneven leg length differences, which is why foot, leg and most musculoskeletal symptoms are rarely symmetrical and identical.  The benefit of a special correction for the short leg is the best long-term approach to treat and prevent a broken sesamoid or sesamoiditis.

Finally, many doctors are unwilling to say they are against barefoot running and minimalist shoes; the patient flow from their use is very profitable.  I prefer my patients to be informed, not in pain and to live without foot fractures or the other disabling physical injuries in the first place.  A broken sesamoid with symptoms usually results in an orthotic patient for life, but as Benjamin Franklin said, " An ounce of prevention is worth a pound of cure."

Dr. Paul R. Copeskey, DC, CCFC

How to treat a broken Sesamoid?

The scope of practice in Chiropractic involves maintenance of the structural and functional integrity of the entire human skeleton.  A doctor of Chiropractic may manipulate any and all of the body's joints, muscles, and connective tissues.  During the course of treatment many physical agents, modalities, techniques, and therapies are used to assist in treatment.  Broken sesamoids can be treated by reducing the forces putting pressure on the big toe and bones when walking or running. 

1. The first factor to consider is shoes; stability and motion control running shoes are a must!  Now is the time to definitely avoid cushioned and minimalist shoes including Vibrams like the plague!  Purchase the best shoes by using the techniques and information in The Right Running Shoes.  Always use stability and motion control running shoes even for walking activities, along with ice therapy a few times daily (20 minutes crushed ice application and/or a 10 minute Dixie cup ice massage.)  Reduce intensity and/or frequency of ballistic activities and time standing on uncarpeted floors.  No barefoot walking and definitely No barefoot running!

2. Foot Pain Taping usually provides immediate pain relief with a broken sesamoid.  This special foot taping is also good for other over pronation symptoms including plantar fasciitis, achilles tendinitis, and shin splints.  This foot taping works because better arch support is essential for most foot and lower leg pain relief.  This technique immediately shortens and supports the origin and insertion points of the plantar fascia, reducing the physical load on the ligament, improving the heel angle and reducing foot pronation.  Along with stability and motion control shoes, this promotes the normal landing toward the outside of the foot when walking or running, reducing the forces on the arch of the foot, heel, big toes and broken sesamoid bones.  This foot taping is actually better than most of the over the counter orthotics like Superfeet, Sole Insoles, and Dr. Scholls.

3. Natural anti-inflammatory supplements:

  • White willow bark
  • Citrus Bioflavonoids
  • Essential fatty acids

4. My most important recommendation to continue walking and running with a broken sesamoid or sesamoiditis is with my custom fabricated orthotics.  These orthotics work two to three times better than the foot taping technique by supporting the feet, forcing the person to toe off the 2nd, 3rd and 4th toes when running or walking and allowing the big toe to basically float during normal gait mechanics.

Sometimes experienced runners cause sesamoiditis (inflammation of the outer surface of the sesamoid bone) by putting too many training miles on their feet, running on hard surfaces or even a road race can trigger sesamoid pain or break a sesamoid.  The good news is that these broken bones rarely need surgery, especially since many of us have already broken one of ours.  Frequently, young athletes break them when natural endorphins are abundant, suppressing symptoms to usually be described only as a "hot" sensation under the big toe.

How to diagnosis a broken Sesamoid?

A broken sesamoid is fairly easily diagnosed by an examination and X-Ray.  This includes feeling or palpating the foot and watching the patient stand and walk (gait analysis).  The history, physical activity description, and foot pain symptoms also help identify the cause and help make the diagnosis.  Using a tuning fork with a vibration and/or ultrasound waves in water will usually provoke pain in a recent sesamoid fracture.  A bone scan and MRI can also be definitive.

This collapsing arch problem is called pronation.  Running in Vibrams and minimalist shoes are also more likely to allow you to injure these small bones because they are not strong running shoes. Cushioned shoes and sometimes even motion control shoes may not provide enough support for an over pronator, resulting in arch pain, heel pain, achilles tendinitis, shin splints or sesamoid pain. 

What is a broken Sesamoid bone and what causes it to break?

There are two free-floating bones under the big toes in our feet called sesamoids.  These bones are vulnerable to anyone walking extensively or running barefoot.  The primary cause of a sesamoid injury is due to inadequate support in the arch area of the foot.

(Sesamoid Bones)

Broken Sesamoid Bone