In my practice I have seen many patient with pain under the 1st metatarsal phalange joint (MPJ), in layman’s terms, the big toe. And some of them come to me after already attempting therapy with orthotics and shoegear modifications including dancer pads and doughnut-type pads. Their usual question is, “Isn’t there another type of pad we can try? These kind of worked but the pain keeps coming back.”
After I review their history and activities, I try to find the source of the increased force at the MPJ. A quick review of the literature reveals that there are sport-specific activities that increase the force to the MPJ that result in sesamoiditis, which is inflammation of the sesamoid bones. The sesamoid bones are located directly under the 1st metatarsal head. Running, volleyball, plyometrics (jumping activities) all increase the force and the amount of flexion and therefor stress to the MPJ of their big toe. Once I identify the source in these patients, I try to stress to them that they need to remove the source of the initial force to the big toe joint. They need to allow the sesamoid to heal. And once the sesamoids heel they then need to alter the force to prevent it from returning. This can be very challenging, especially with athletes.
In the case of a volleyball player, an example would be to have the player propel or jump off the entire foot as opposed to the MPJ of the great toe. Plyometric strengthening activities performed barefoot can help teach this as well as increasing the activation of the lesser toes. It is important for athletes to do these activities barefoot as their proprioception is higher. I know I have discussed this before in another blog post, so as you know propioception is the ability to sense stimuli arising within the body regarding position, motion, and equilibrium. When athletes does these exercises barefoot, they can feel the pain in the great toe, notice when they are placing too much pressure there and therefore learn to activate the lesser digits. It
By increasing the strength of the lesser toes by activating the extensor digitorum longus and brevis muscles, the foot can become stronger and take some of the load off the extensor hallucis longus and brevis tendons. In my clinical experience, I have found that strengthening the flexor hallucis longus, flexor hallucis brevis, extensor digitorum longus and extensor digitorum brevis muscles can relieve the pain within the sesamoid complex. It is without a doubt a frustrating and longstanding injury that can sometimes take months to overcome. However, I have had much more success with changing the activity and force than with padding or offloading.
I am linking up with Jill Conyers for Fitness Friday, where bloggers share their health and fitness blog posts, make new friends, and find inspiration