Today on the Doc On The Run Podcast we’re talking about how big toe positioning can actually help a medial tibial sesamoid stress fracture or bipartite sesamoid disruption.
This episode actually comes from a call that I was doing, a consultation call on webcam with somebody who had a tibial sesamoid stress fracture. And interestingly, his doctor wasn’t even sure what it was, if it was really a crack in the bone that wasn’t healing or if it was what I call a sprain of the bipartite sesamoid.
These are actually two different bones in the soft tissue in between is disrupted but in any case, he’s having pain right here, because there’s too much stress and strain on that sesamoid bone. And so, we were talking about ways to decrease the stress and strain on there. One of the things he mentioned that he was using a toe spreader that he had bought where you basically put this contraption on your foot, they usually look, they’re sort of like they’ll have little rubber things in between all the toes, and they have little loops that you put on the toes most of the time they’re silicone rubber. But basically, you put it on the toes and those little bumpers actually spread the toes and it pushes the big toe over. It changes the position of the big toe by moving it over because there’s this big rubber thing, pushing it that way.
What does that do? Well, it’s really simple. When you push the big toe over, you actually decrease the amount of stress on the sesamoid bone because the flexor hallucis longus tendon is embedded in here and when you tilt the toe to toe over, it decreases the stress there and it increases the stress over here. So, irrespective of whether you have a stress fracture in that sesamoid bone or you have a sprain, basically the soft tissue that connects the two pieces of bipartite sesamoid where there are two separate bones in there, that will actually decrease the stress and strain.
But basically, if you take the toe and you just pull down and out on the toe, the decrease of the stress and strain on the sesamoid bone, if you think about it, if you’re pulling the stress fracture apart, if you’re pulling disruptions soft tissue apart, that actually takes longer to heal. So, if you put tape on the outside of the foot and pull it down to let that relax a little bit, theoretically, it should help it heal faster.
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