The Trainer’s Room: Treatment & Rehab Recommendations for Sesamoiditis and Turf Toe

(The Trainer’s Room is a regular column at Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy, the pain and rehabilitation experts at the Mountain View Pain Center in Denver, CO.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.

You should always consult your doctor before beginning any pain management or rehab program.)

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Sesamoid Bone Injury for Beanie Wells?

With the upcoming draft, questions have been raised about a potential sesamoid bone problem for former Ohio State running back Chris “Beanie” Wells. Peter King of SI.com got the ball rolling on the speculation in his recent Monday Morning Quaterback post, saying simply, “Some teams are scared off by a sesmoid bone problem in one of big back Beanie Wells’ feet.” Once the story of a potential sesamoid bone problem for Beanie Wells hit ProFootballTalk, there is a good chance everyone who follows the NFL was aware of the speculation. (Between the issue being raised in Peter King’s MMQB column and at ProFootballTalk, it would be hard for NFL execs and fans alike to miss it.)

To be fair, the player and his agent have denied that Beanie Wells has a sesamoid bone problem in his foot, calling the sesamoid bone concerns a “smoke screen.” As we all know, it is hard to trust any information disseminated about draft prospects this time of year. Teams picking later in the draft may want negative information out there about a player to increase the chances of the player not getting picked as high as he otherwise might be.

Either way, whether Beanie Wells truly has a sesamoid bone problem or not, last season the Buckeye standout was plagued with a foot injury that kept him out of three games and possibly hurt him in the chase for the Heisman. And now the information referenced above has surfaced about a potential injury in the fore foot.

The possible injury, described as an inflammation of the sesamoid bones below the first metatarsal (big toe – as pictured below), will no doubt remain a hot topic as we approach the first round of the 2009 NFL Draft on Saturday.

Under view of the foot

For the record, this article makes no claims as to whether or not Beanie Wells truly has a sesamoid bone problem, only that the speculation is out there. Rather, this edition of The Trainer’s Room is meant to serve as general information on sesamoditis, its similarity to turf toe, and methods for treating the injuries.

Sesamoiditis and Turf Toe

Sesamoiditis refers to any irriation of the sesamoid bones. The sesamoid bones are free floating bones throughout the body, encased in a tendon sheath. These can be found at the base of the first metacarpal (thumb), first metatarsal (big toe), and patella (pictured below – the largest sesamoid bone in the body). Their main function is to hold the tendon away from the joint slightly, protecting the tendon from wear and tear by decreasing friction and increasing joint function.

Patella encased in the tendon

Inflammation of the sesamoid bone is a very similar injury to another very common sports injury, known as turf toe. These two injuries have many common indicators and are often intertwined.Both sesamoiditis and turf toe produce complaints of sharp to very intense pain underneath the base of the big toe. Most of the pain comes from extension of the toe, which can cause difficulty walking and a tender and swollen joint.

Sesamoiditis is an inflammation of the sesamoid bones from overuse or chronic stress to the area. Sesamoiditis will begin as a more gradual ache and then increase in pain over time. Turf toe is an actual tear or injury to the soft tissue underneath the first metatarsal (big toe). Turf toe usually will be an immediate pain. The patient will often feel a pop in the area underneath the 1st metatarsal head. Remember that sesamoiditis and turf toe are similar injuries that have similar symptoms and may accompany one another. You may have a chronic turf toe problem from damage to the area, but the pain does not have to be sudden.

Causes of Sesamoiditis and Turf Toe

The most common way to receive one of these injuries is forced hyperextension of the toe, jamming the joint, or repetitive stress (common in sprinters and football players). For a running back like Beanie Wells this injury can be detrimental to their ability to get down the field by decreasing their ability to get in and out of cuts quickly and hindering their all-important burst through the hole.

Inflammation of the bones or a tear in the ligaments as in turf toe causes the pushing power to be greatly decreased. This will decrease the explosiveness and overall speed of any player. In severe cases athletes may not be able to run at all. This is a very common and simple injury, and the pain can keep you sidelined for weeks. In the past year several other athletes such as LT and Darren McFadden were out for weeks with toe injuries.

Sesamoiditis Treatment and Turf Toe Treatment

The acute stages of sesamoiditis and turf toe are painful and intense. Any additional pressure is going to increase that pain. When sesamoiditis or turf toe first occurs, ice the area to decrease the inflammation. You can use ice for either injury, whether it is chronic or acute. Ice is one of the best ways to decrease inflammation immediately following the injury.

The next step is pay a visit to your doctor. Neither sesamoiditis nor turf toe will just go away on their own. The longer you wait with an injury like this the longer it will take to get back on your feet. Your doctor will perform orthopedic tests to determine which injury you are suffering from. An X-ray will be taken to determine if there are any underlying fractures or dislocations. They may also take an MRI to determine if there is in fact any ligament or tendon damage. An MRI can also detect soft tissue swelling or inflammation to the bone which cannot be seen on X-ray.

Once the diagnosis is given, the first and most important step is to free the area of inflammation and swelling. This can be done by several different types of treatment. The big toe is not a great site to attach pads for any type of electrical modalities. For this reason, at Mountain View Pain Center in Denver we use ultrasound under water to remove the inflammation of this area. Note that the area is very thin, so ultrasound should not be applied directly.

After the first treatment it is important to apply tape or a specific brace to prevent the toe going into extension and thus creating extra pain. At Mountain View Pain Center in Denver we prefer to use a specific taping method to keep mobility in the ankle and allow for more comfort. The tape allows the toe to be held straight and decreases the amount of extension during push off. During your sport of preference wearing shoes with a stiff sole will also increase the stability in the area and decrease the amount of extension.

Once stability has been restored to the area, and the pain has slightly subsided, it is important to have the foot adjusted (manipulated) to restore proper movement to the foot, ankle, and metatarsals. After the area has begun to heal, soft tissue technique should be applied to the area. The importance of this step is to not only continue the removal of inflammation, but to also break up scar tissues and adhesions that have formed in the tendon sheath. At Mountain View Pain Center in Denver we use a combination of soft tissue stretches, as well as a specialized tools to work through the area.

Sesamoiditis Rehab and Turf Toe Rehab

There are also some exercises we use to aid in the healing process and to strengthen the area. They should only be done when you can perform them without pain.

Start simple with toe crunches, which will help build the muscle at the bottom of the joint and assist in preventing future occurences of sesamoiditis or turf toe. A toe crunch involves bending the toes as if trying to pick a ball of the ground with your toes.

The next rehab exercise is only to be done when there is no pain at all when standing, and should be performed after several treatments. You can go from a flat footed position to a toe raise (similar to a ballet move). This is an advanced exercise for these injuries so take it easy and do not try this exercise first.

What to Avoid

Things that are important to avoid during recovery from sesamoiditis and turf toe are any movements that involve a pushing off of the toe. What this means is cut out the plyometrics, hills, and stairs from your training regimen. If you insist on training, then get on a bike and push the pedal with the middle of the foot or heel. Another substitute can be the elliptical machine. Be sure to take long even strides and stay off the toes. This entire exercise can be done with the foot flat. If you find either exercise to painful then perform the one you can.

Although many think a toe injury cannot keep them down. This injury, year after year, keeps players on the sidelines for extended periods of time. The pain is intense and debilitating, yet although this is a very painful injury, if the correct steps are taken, you can recover and get back to full speed.

As for Beanie Wells and the speculation that he may have a sesamoid bone injury, only time will tell. If he does, in fact, have a sesamoid bone injury (and again, it is all purely speculation at this point) then if the toe is properly rehabbed and time is taken before getting into hard core training, we should expect to see him back on the field for training camp.

Now, whether his impact on the field will be similar to his college career, that is what hundreds of scouts and personnel people are trying to figure out leading up to the start of the draft tomorrow.

This article contains the opinions and examples of treatment plans for sesamoiditis and turf toe from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.

Tags: 2009 nfl draft, Beanie Wells, sports injuries

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