A Solution for my Sesamoids!
7/7/97

  Thirteen may be an unlucky number, but accompanied with prayer, it
becomes the doctor that solves my foot problems.  After 12 other
orthopedic, chiropractic, and podiatric doctors, and 165 missed days
of running, Dr. Craig Katzenmeyer, picked up on something overlooked
by others.  Something I started doing 10 years ago.  After trying
everything from olive oil and metatarsal pads to wooden shoes and
lower leg casts, the answer was to "relax the forefoot".  I know it
sounds amazing that I can "relax" my foot and start pounding the
pavement only a week after 5 California College of Podiatric Medicine
doctors concurred I had an acute fracture of the left fibial sesamoid
and must alleviate the pressure on my feet.
  But it's working.  
And it's the first real success I've had in 6 months.  I've run 32mi
in 11 days and it's better every day.

  This injury is the longest set-back I've had but I'm glad in it
because I had faith in God and he made it an opportunity to relate &
console with other injured friends and, I'm sure, like past injuries,
will use it to improve me.

--> Following are lengthy, boring details..... only for those really
interested...

FIRST, SOME BACKGROUND
The symptoms:  intense pain in the ball of the forefoot (1st
metatarsal joint) when running and even walking, driving, or pushing
off the wall swimming.

Foot type: "a rigid cavus foot structure with plantar flex of the 1st
met.  Limited hallux dorsiflexion and a bowstrung medial slip of the
plantar fascia.  Feet are supinated during midstance w/ no pronation
appreciated.  X-rays show bipartite tibial and fibular sesamoids"
(this differs between doctors)

Initial diagnosis:  Because the foot is so rigid it doesn't want to
pronate and absorb shock.  Furthermore, the 1st metatarsal  protrudes
downward causing it to take more shock.  And the limited hallux
dorsiflexion and tight Achilles tendon limit pronation even more. 
The end result is that my foot is a rigid tri-pod with 7 times by
body weight of force on the sesamoids (which are tiny bones below the
joint of the big toe)

Doctor's View:  Although I always suggested studying the mechanics of
my walking/running, the Doctors were all set on treating the
symptoms:  soft pads to cushion the sore joint, weight distributing
inserts to shift the weight elsewhere, stiff shoes that wouldn't bend
the joint, leg casts to shift the weight to the heals, and orthotics
to move pressure to other parts of the foot.

Other Treatment:  I increased fat intake to build up "fat pads" on
bottom of feet (doesn't work), I swam with soft neoprene booties to
cushion feet from the cement walls, I wore size 12 shoes instead of
10-1/2 to fit all the cushion inserts, I massaged, stretched, iced,
heated, elevated, and cut holes in my shoes.

And it was always painful to walk.  I was always compensating, trying
to keep the weight off the insides of my feet.  But it just hurt
more.

Pronation:   Pronation is very important, it absorbs shock of running
by allowing the 1st met (the big toe joint) to move upward as the
arch moves downward.  Like the leaf springs on your car.

NOW FOR MY THEORY
In 1988, when I changed my running form, I went from "pronater" to
"neutral/suppinator".  I constantly held my foot in a rigid cavus
position to prevent my Achilles tendonitis problem.  Many coaches and
experts confirmed that I now had perfect neutral form.  I kept the
tendons near the arch and over the 1st met joint constantly tight to
decrease pronation, and consequently increased the pressure on the
sesamoids.  The tendons became inflamed.  The sesamoids, not allowed
to move fluidly in the tight tendon, became injured and the
intersesmoidal and colateral ligaments became inflamed.
Compensating more, I held my foot tighter, in a suppinated position.
This would relieve pressure from the inside.  But actually it just
increased the pounding forces on the ball of the foot, and the
tightened ligaments grew more painful.  I experienced a barrage of
other injuries including stressed ligaments in my ankle and anterior
foot, pain in the 3rd met, and Achilles pain.  The inflammation was
spreading and a bursa developed in the joint.
   I believe that without a change in my mechanics, no treatment
would have been successful.
   By relaxing the muscles in the arch and forefoot, the foot is now
allowed to roll and take up shock and the sesamoids are allowed to
fluidly function during toe-off.  This was mentally challenging
because the ball of my foot hurt and now I was to relax and stand,
walk, and run on it normally!  But I felt immediate relief!

  As I revert back to the running form of my teens, I must be careful
not to overpronate and bring on the Achilles tendonitis.  I believe I
can protect against this with arch supports or just proper
anti-pronation shoes.  The key is that I will still be pronating more
than I've been allowing myself for years.  I am also constantly
stretching the Achilles and wearing bigger shoes.
   I'm glad I spoke to Dr. Craig Katzenmeyer.
   One of the next treatments would have been a tibial sesamoidectomy.

-Troy