Chiropractor Chandler AZ
The sesamoid bones are very small and commonly found in tendons that provide attachment points or help change the angle of muscle pulls, such as using a pulley to change direction of pull. The most common sesamoid bones that are injured or become irritated are located at the bottom of the first metacarpophalangeal joint or big toe. These very small bones can produce severe pain that limits walking and standing.
The sesamoid bones are used by the flexor hallucis longus muscle, which helps flex the big toe during walking or running. They are the site of attachment for several muscles including flexor hallucis brevis, abductor hallucis, and abductor hallucis muscles.
Pain localized underneath the big toe that is increased with resisted toe flexion may indicate either tendinitis, sesamoiditis, or sesamoid fractures.
Direct trauma or repetitive use are the most common causes of sesamoiditis. Running and jumping places significant stress on the soft tissue underneath the feet and big toe. Jumping from an elevated height and landing hard on the ground dramatically increases the force and strain on the bottom of the foot. Sesamoiditis is often the result of poorly fitting shoes and increased pounding activities on hard surfaces.
Rest and ice are the most common and effective treatments at home. Rest relieves the stress and strain applied to the sesamoid bone, muscles, and tendons on the bottom of the foot. Especially reducing walking or running on hard surfaces gives the sesamoid bones a chance to heal. Many patients will place a thin doughnut-shaped pad underneath the big toe to help relief direct pressure and further enhance healing. Avoiding very flexible shoes and replacing them with stiffer shoes will help reduce the strain on the ball the foot. Many patients try walking on softer surfaces and avoiding walking barefoot on hard tile.
Your healthcare provider will perform an evaluation of the foot and toe before beginning treatment. X-rays are very commonly utilized to evaluate fractures to the metatarsals, phalanges, or sesamoid bones in the foot. Once it it is determined a fracture is not present, active treatment can begin to decrease pain and inflammation. Your primary care is concerned of the high rate of sesamoid fractures becoming displaced, because of the attachment of the flexor hallucis brevis and its strong pull across the bones. Continued contraction of this muscle during walking or running leads to high rates of delayed or nonunion fracture healings.
Office treatments continue to focus on decreasing the stress to the bottom of foot and toe, in addition to decreasing the inflammation. Cortisone injections are not usually the first line of treatment but can be considered in some cases. Specific taping or strapping can be utilized to help support the area and further reduce stress on the foot.
Cold laser therapy or low-level laser therapy is becoming a treatment option for decreasing pain and inflammation, in addition to enhancing healing and repair. Class IV cold lasers utilize specific wavelengths and energy to penetrate deep within the tissue to encourage cellular growth and repair. Cold lasers are an excellent treatment for increasing cellular ATP energy, which can be used to help the cell repair faster and remove waste products. Muscles, tendons, and ligaments exposed to low-level laser repair regenerate faster than tissue where treatment is not applied.
Cold lasers have been used in treatment for many years to increase vasodilation, or increase blood flow to the tissues. More blood flowing to an area brings greater supply of nutrients for healing. In addition, this therapy of increased blood flow helps remove waste products and inflammation from the injured area. Swelling is dramatically reduced when cold lasers are combined in the treatment plan.
Class IV cold lasers are excellent at decreasing pain signals that are traveling to the brain. They shut off or desensitize the pain nerves and their signals that people feel with every step they take. In addition to decreasing pain signals, laser therapy increases endorphins and enkephalins, which further decreases pain sensation and perception.
Additional conservative treatments performed for sesamoiditis include acupuncture, massage therapy, active release technique, Graston technique, or reflexology. These treatments address the muscle spasms associated with ankle and foot injuries. Whenever a person experiences tendinitis or injury to any area of the foot, the other muscles surrounding the area contract to help protect the injured tissue. Unfortunate prolonged contraction may slow tendinitis or tendinosis injury repair and recovery. In addition, sometimes the chronic muscle spasms of the lower leg and foot muscles increase the likelihood of developing soft tissue injuries or sesamoiditis.
Conservative treatment works to address all dysfunctions in the lower leg, ankle, and foot. Increasing flexibility in these muscles reduces the likelihood of compensation injuries in the foot. Some foot and ankle injuries occur because of muscle weakness in the feet and leg muscles. Physical therapy or strengthening treatments can be applied to address muscle weakness or lack of endurance.
Orthotics or changes in footwear may be recommended during the acute and repair phase of the treatment plan. Some patients find that they have been wearing the wrong types of shoe for both their feet and their recreational and athletic activities, and getting a properly supporting running shoe specifically for their foot reduces their foot pain.
Injuries that occur in the foot and toes may be the result of tendinitis, fractures, or excessive pounding activities on the muscles and joints. These types of injuries respond well to home treatments and in-office treatments that address the pain, inflammation, weakness, and lack of flexibility in the lower leg and foot. Cold laser therapy is an excellent treatment at addressing the pain, inflammation, and swelling associated with these types of injuries.