Sesamoiditis…a sore big toe
Dance Medicine Physiotherapist Samantha Wolfenden checks pointe shoe fittings
By no means is this a dancer only condition as I see this ailment in almost anyone, having said that, tight shoes including pointe shoes are a big culprit here. Sesamoiditis is inflammation of the sesamoid bones of the bone toe. This condition can present as acute in onset from a direct blow but usually it is to do with tight shoes, incorrectly fitting pointe shoes, and less than ideal kinematics of the lower limb.
Signs and symptoms include: swelling of the big toe, tender to touch and pain can extend over the top of the foot causing problems with walking, pushing off with the big toe, wide seconde loading, and pain with tight shoes or unsupportive footwear like thongs.
If you take a look at the pointe shoe itself, a rigid structure, given what it has to do, with a box in which the toes sit with winged edges up the sides. Ideally the 1st Metatarsal joint should line up with the box but in some cases when the shoe doesn’t fit you can get excessive rubbing on the inside of the big toe which contributes to sesamoiditis
As part of a conservative treatment approach I like to pad the irritated bone with a removable sling that I custom make for the patient so they can continue to wear shoes with padding and continue dancing. In time, this condition will settle if you let it, but a busy training schedule and life can get in the way. So here are a few tips:
get a trained professional physiotherapist such as myself to check the pointe shoe fit (if you’re not sure, click here to learn about pointe shoe fittings)
when you aren't dancing, wear supportive shoes (high heels and thongs don’t count)
never consider that pain is normal as it isn’t
ice is your friend, when used correctly (ask the physio)
lastly, the sooner you get it seen to the better
Sam’s area of interest is working with dancers, particularly in the pre-professional/adolescent population. Dance medicine is a unique area to be involved in and you can be sure that she’ll get you back to doing what you love. All consultations with Sam can be made by contacting the clinic directly either via our social media platforms or email/phone.