Friday, April 16, 2010

Sesamoiditis and Dirt

I'm writing a blog about my sesamoiditis injury since I haven't found much in the way of sesamoiditis and cycling.  To date I've heard from one other person that is a cyclist and had it.

It doesn't appear to be a big cycling injury, and seems fairly rare for cyclists to have.  As such, I have no idea what caused this for me, but am stepping up and claiming it as my first over-use injury.

Sesamoiditis is inflammation of the sesamoid bones (a bone embedded within a tendon and found in locations where a tendon passes over a joint - such as the hand, knee, and FOOT).  It occurs on the bottom of the foot, behind the large toe.  Sesamoids (as I've seen on my xrays) are about the size of jelly beans, or for those of us that are exercise-oriented, Sport Beans.  Apparently sesamoiditis is caused by either the sudden bending upwards of the big toe, high heels (ahaha), or a stumble.  It seems to be somewhat common in young people engaging in physical activity like running or dancing.  Indeed, most of the metartsal pad information I found was on running or dancing sites/forums.  Sesamoiditis is essentially just a general description for any irritation of the sesamoid bones.  Every time you push off against the toe the sesamoids are involved and can eventually get irritated or fractured.

The onset is really gradual (as I found).  The pain starts off as a mild ache and increases slowly as the aggravating activity (or, IMO, just any activity what-so-ever, including walking) is continued.  As noted here sesamoiditis can be caused by increased activity, and this can put more pressure on the balls of your feet.  Speedwork, hill work, or increased mileage can all contribute, especially if you have a bony foot (not enough fat to protect the fragile sesamoids).  This is more in tune with running than cycling, as obviously cycling is a much more low-impact activity overall.

When I saw a second doctor about my sesamoiditis (the first was a general practioner who suggested padding my inflamed sesamoids - which I did, and it got worse - and custom insoles - which I didn't do, and should have - and the second a podiatrist, where I did get custom insoles for both my cycling and my every day shoes) he asked how much time I could take off the bike to let it heal.  I said 4 days.  He gave me a "look".  "Maybe 5."  I took 2 days off, did a ride, then took 9 days off.  By the time I did my next ride I had metatarsal pads, which definitely helped, but didn't solve the problem, and my foot was hurting pretty bad about an hour in to the ride, and really bad 1.5+ hours in.

It may not look like much, but I assure you, this was a few days ago, and it has off/on felt much worse than it has looked!

I got my custom orthotics back this past Monday, and have been wearing them pretty much full time (whenever I have shoes on) and have done two rides with cycling shoes this week.  My foot is generally pain free in every day shoes walking around, which is a nice bonus.  The blood blister/bruising that I have from this whole ordeal does not seem to be dissipating.  Riding earlier this week in my cycling shoes with orthotics also caused pain just over an hour in, but not as bad as last weekend, so I guess that is a plus.

Here are the stock Specialized S-Works mountain bike shoe insoles:

I noticed that they do include a metatarsal button:

So while there is a small area cut out for similar issues, it isn't quite like the custom bit I've got now.

I'm actually almost surprised that the left insole doesn't have a button cut out as well.  I would imagine it's possible for this to also occur with my left foot.  

For comparison, here is the weight difference - 

Guess I should consider not riding with the custom insole in the left foot.  It'd save a few grams!  That's for you, Keith B!

Well, enough about sesamoids for now...

I'm back on the training wagon at last, and it feels sort of good.  My legs are sore today, but I can still walk up the stairs at work to my desk without the burning "OMG someone kill me now my legs are barely functioning" feeling I had for the last 3 months.  I'm not worried; it'll come back soon.

Was just packing up for my training ride off-road yesterday and realized that my bike was still in race-mode from Fontana.  That doesn't mean anything other than A) it was in pretty good shape still, and B) I didn't have a power tap on it.  

Wanted: training partner that is low maintenance and similar to my speed on climbs, yet challenges me on descents.  Doesn't mind waiting for me or occasionally listening to me whine.  Must be a detail-oriented bike mechanic and carry more stuff than I do for rides (e.g. one more tube, one more C02, multi-tool, etc.).  I make bottles and can cover nutritionals.  Call me.

Anyway, so Justin came out to the garage to try to assist me in changing out my rear wheel (which I realized meant I had to change cassette's on the hub, which we then realized meant I had to change brake calipers to fit the 160mm rear brake instead of 140mm).

Yeah, I'm removing my XX cassette!

Now I'm working on the brake caliper

Justin still helped a little, but it felt kind of cool to wrench on my own bike.  I just hope no one gets any kind of ideas that this will be a regular activity going forward.  I'm like Cole Trickle... or rather, I want to be.  I want to get in the car and drive.  I don't need to know what I'm talking about!

Nah, actually I think it's a great opportunity to learn to do my own wrenching.  I'm long over-due.  Unfortunately I don't have time to learn that much since I picked up some extra slack lately.

I did finally get to the trailhead, though.

Solid riding.  No snakes today (I guess not too surprising as there wasn't much available sun).

For those of you concerned...we've been eating well lately!  "Splurged" on quinoa twice this week.

Yes.  I like grilled bell peppers.


Luke said...

hahaha...i can cover everything but the making bottles and covering nutritionals part. so what's my salary? jk!

good post...good to see ya back at it!

allison said...

Luke - no *I* will make all the bottles and bring the food! Recovery included! :)

Zippy said...

Sounds like I should send you my resume. LOL!

beth said...

so the sesamoiditis is all better? just a thought- if it gets worse, since it seems to be related to those who do things on the balls of their feet, maybe you could try a midsole cleat postiion? i know a lot of road people do, but not sure how it would translate for MTB...
and hey, you are a dancer! not your fault if you "dance on the pedals"...

allison said...

Beth - details? What is a mid sole cleat position? I moved the cleats back a tad on the road shoes. Need to add that to my to-do list for my mtb shoes :)

Stephanie said...

I'm always down to train with you but I can't keep up on the climbs :)

nsoni said...

Hey how's your foot doing? I used to be a runner and I was diagonsed with sesamoiditis just 3 months ago. My pain got so bad that my orthopedist put me in a surgical boot and asked me to go on crutches for next 6 weeks!

Devon said...

Did you eventually fully recover? I'm dealing with this crap too..

allison said...

@Devon - no way to email/contact you directly so not sure if you'll see this, but, it's an ongoing process. It recurred very badly January 2011 and took me off the bike for the better part of 4 months since it was much worse. This year I have taken additional measures to ensure my foot health and so far so good.