#887 Single most important stretch for Sesamoid fracture in runner - DOC

#887 Single most important stretch for Sesamoid fracture in runner

What is the single most important stretch if you are a runner who has had a sesamoid fracture? Well, that is what we are talking about today on the Doc On The Run Podcast.

 

 

If you get a sesamoid fracture, you are probably worried and deservedly so. This is a scary injury if you are a runner. Let us talk about sesamoids and what they are and why you can think about stretching and why it might help you.

If we look at the forefoot, go ahead and make comments about my drawings. I know they are no good, but this is the best I can do. I am a podiatrist, I am not an artist. So, you have the first metatarsal bone sitting here, sesamoid bones are underneath there. You have the proximal phalanx bone, and you have the distal phalanx bone, the flexor hallucis longus tendon, it goes along there, those bones are embedded in the flexor hallucis longus tendon.

When you look at this from the side, we are looking underneath the foot where the big toe is. You have the first metatarsal bone, proximal phalanx, distal phalanx and sesamoids and that flexor hallucis longus tendon is here, it goes up your ankle. Well, there’s a couple of other things that really pull on the foot. I’m not going to draw all this stuff in here that is in between the heel bone in here. You got a bunch of stuff, it does not matter what it is.

You have the Achilles tendon. So, you have the FHL tendon, and you have the Achilles tendon, right? So, you got your big old calf muscle up here, comes down and attached here. This is the largest tendon that you have in your foot and FHL tendon is just going out to your sesamoid fracture. And if you think about this, what is the biggest problem with a sesamoid fracture? Well, the biggest problem is if it is broken, if it is in two pieces like this, the last thing you want to do is pull on it in that direction, and in that direction and you do not want to crush it. You do not want to apply a lot of pressure to it in this direction.

There are two ways that you are going to apply more pressure. One of them is moving the big toe up and the other is pulling up here with your Achilles tendon because when you pull up with your Achilles tendon, you are driving the sesamoids into the ground, and that can cause damage to a sesamoid bone that is healing. You also do not want to pull on the big toe. So. the worst stretch you could do would be this one because if you pull up on the big toe, you are pulling that way on the end of the FHL tendon and you are stretching the sesamoid that has a fracture. So, you do not want to do this. No, no, no, bad idea.

Instead, you want to stretch the Achilles because when you are stretching the Achilles, you wind up with less downward force on the sesamoid bones when you are walking, when you are standing, when you are running. Another way to do this badly would be to walk up to the wall, because the common way people do these Achilles stretches to make it more powerful, is to actually put their foot up against the baseboard and then they lean forward so they are pulling their heel up, you know their Achilles tendon down, like basically forcing and trying to keep the heel down on the ground and keep it from coming up away from the ground, but they are putting additional leverage with the big toe against the wall, as that is even worse.

Do not do that. You do not want to do anything that stretches the sesamoids, and it is better to decrease the stretch and the Achilles tendon so that it is not pushing with as much force on the end of your lever that we call your foot because your foot, although it’s got a lot of bones and stuff in there. It is just a fancy lever on the end of your leg and the tighter the Achilles tendon, the more torque and more pressure on the sesamoids at the end of your foot every time you take a step.

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