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What's the best conservative tretment in a player of sesamoiditis and fhl???

 

Ice

rest

NSAIDs

and Anything which reduces the GRF plantar to the 1st MTP joint.

 

Does the patient have a plantarflexed 1st met (i.e. 1st ray) and have an everted ff to rf relationship? If so, then an orthotic device with intrinsic ff valgus support and a sulcus length top cover with a 1/8 inch Korex (approx 3 mm) extension to the sulcus with a very local accommodation (aperture) under the sesamoid(s) tends to work very well to offload the 1st met and sesamoid(s).

 

Look @ the pts boots(cleats), would they be too big and there is a stopper sitting under the 1st met?

 

A very simple solution that works surprisingly well is to simply grind down the thickness of the shoe studs of the soccer boot that are in the 1st metatarsal head area. Generally grinding down these studs by about 2 mm greatly reduces the stress on the sesamoids during soccer. I have done this on numerous occasions with excellent results for many patients.

 

Kevin, do you find this works with 1st ipj pain also? Or could that potentially be more of a saggital Plane issue?

 

Alternative/addition to Kevin's approach get molded boots (rubbers) that are normally for hard ground and get a cobbler to grind the back studs off and put in threads for screw in studs so the player can put in longer studs in the winter softer pitches but still keep the softer fore foot option.

 

Grinding the studs is the same thing as kinetic wedge or a reverse Morton's extension

Eric

 

After experiencing "sesamoid" pain continually (during and after soccer and touch football), I eventually discovered the "reinforcing" pins directly under my 1st MPJ area (hidden under the inner sole). The plate containing the moulded studs is glued on, but these reinforcing pins are located only in 2 sites, the plantar- tip of toe area and sub-1st MPJ. I removed them with pliers, but unfort a lot of damage had already been done. Still suffering! I alternate with either offloading techniques or cushioning during the game, depending on which one provides the least pain at the time. I really think Kevin's idea will help further. I'm going to give it a go.