You’re working hard in dance class, but there’s an aching pain in the ball of your foot that just keeps getting worse as class goes on. You don’t really remember when it started but that ache right under your big toe gets harder to ignore every time you dance. If this sounds familiar, you could be experiencing pain in your sesamoid bones, which when left untreated, can become sesamoiditis, or chronic inflammation of these tissues.
WHAT ARE THE SESAMOIDS BONES?
When we talk about the “sesamoids,” we’re talking about two small bones in the ball of your foot that sit within the tendon of a muscle. From a mechanical perspective, these two tiny bones serve the important function of giving this muscle more power; but from a dancer’s perspective, sometimes it seems like their only job is to cause pain.
There are many factors that can contribute to these bones getting irritated and becoming inflamed, but for Irish dancers, the main cause of sesamoid pain is limited big toe dorsiflexion, or a stiff big toe joint. Irish dancing requires dancers to stay as high on their toes as possible, including when landing huge jumps like leaps and birds. To achieve this, ideally dancers should have 90 degrees of dorsiflexion in this metatarsal phalangeal joint (MTP joint, also known as your big toe joint) as seen in the photo.
Even when the MTP joint does not have this much available range of motion, as dancers we often force the joint beyond its comfortable range in order to get higher on our toes. This increases the strain on all of the structures surrounding the MTP joint–especially the sesamoid bones. Forcing this joint into this position over and over (and over) again creates chronic inflammation around the joint that results in the achy pain of sesamoiditis.
WHY DO IRISH DANCERS SUFFER FROM SESAMOIDITIS?
One reason we’ve already mentioned is the unique style of Irish dance–we land jumps with straight knees on the balls of our feet as opposed to ballet dancers, for example, who land with soft knees and flat feet. Another significant contributing factor is the shoes we wear in Irish dance, specifically ghillies.
To achieve the right “look” in soft shoes, you’re likely wearing a pair of shoes that are a few sizes too small and squeeze your feet awfully tight. Without room for your toes to spread out, the muscles in your feet can’t work properly to support them, leaving the sesamoids susceptible to injury. Think about what it would feel like to try and write if all of your fingertips were taped together–all of the tiny muscles in your hand wouldn’t be able to work the way they should to help you write normally. That’s exactly how your toes feel in your dance shoes.
WHAT CAN YOU DO ABOUT SESAMOID PAIN?
While we can’t change the mechanics of Irish dance, there’s a lot we can do to support our feet to prevent or reduce sesamoiditis.
Address the alignment of your big toe
Several factors can alter the alignment of the big toe, such as too small of dance shoes. For all exercises outlined below, begin by making sure the big toe is aligned with the first metatarsal (the long bone in the foot just behind the big toe). We also recommend using toe spacers like the Naboso Splay. These are great to wear while doing homework, while walking around at home, while you're stretching, etc.
Improve the mobility of your MTP joint.
A stiff big toe joint is a major cause of sesamoid pain. If we can increase the mobility of this joint, you’ll be able to get higher on your toes without increasing the strain on the sesamoids. Check out some of our favorite exercises for increasing MTP mobility below. NOTE: If you’re currently experiencing sesamoid pain, be gentle when doing these exercises. Do not push past this pain to try and force more range of motion.
Prayer Hands with Foot
Interlace one hand's fingers in the opposite foot. Gently pull your toes away from the base of your foot and bent in either direction, twist your foot from side to side (like you're wringing out a wet towel).
Big Toe Press
Place your foot flat on the ground keeping the "tripod"of your foot connected to the ground (the ball of your foot, heel, and baby ball of your foot). Gently pull your big toe up to stretch and hold it for 5 seconds. Then press your big toe down into your fingers for 5 seconds, resisting with your fingers.
Improve the strength of your intrinsic foot muscles.
Building strength in these small muscles in your feet will help better support all of the joints in your feet, including the MTP joint. Try these exercises to start working your intrinsic foot strength. For all of these exercises, focus on keeping your "tripod" (the ball of your foot, heel, and baby ball of your foot) firmly planted on the ground.
Toe Spread and Reach
Lift your toes off the ground, keeping your tripod down. Spread your toes as wide as you can, then lower them back to the ground thinking about lengthening all of your toes away from you.
Keeping your tripod on the ground, lift your big toe and press your baby toes into the ground, then switch. Repeat.
With your tripod resting on the ground, pull the ball of your foot closer to your heel to lift your arch, then relax.
Give your feet some love!
Your feet work hard to support you while you dance, train, and even just walk between classes, so a little TLC can go a long way! Try some of these activities to improve the mobility of all of the joints in your feet and release the tightness in the muscles.
Massage Ball Rolling
Using a lacrosse ball (or another firm ball) press the arch of your foot into the ball and roll it around. If you find a tight spot, hold there for a few counts taking deep breaths to relax your foot around the ball.
Another tool we recommend for dancers looking to manage the symptoms of sesamoiditis are dancer's pads. These pads are designed to offload the sesamoids (reduce the amount of impact these sore bones get) with a cutout in the pad where the sesamoids sit. We love THESE dancer's pads from MyFootShop because they have a cutout in exactly the right place to offload your sesamoids, they're reusable, and have two options for thickness of the pad that both fit into even snug dance shoes.
Dancer's pads are great to help manage the symptoms of sesamoiditis, but do not address the underlying causes we addressed earlier in this blog post. If you do experience sesamoid pain, make sure you're taking care of the injury with the tips listed above AND by seeing your doctor or licensed physical therapist to help you prevent further injury.
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