Injuries to tendons
Tendons connect muscles to bone. They have a poor blood supply but have high tensile strength. They are elastic but lose elasticity with ageing. Tendons may be partially or completely ruptured. A complete rupture shows loss of suction of that muscle, but the rupture may be masked by other muscles. Partial rupture causes pain and weakness but some muscle function is preserved. Total ruptures are usually repaired surgically whereas soft issue treatment is usually appropriate for partial ruptures.
Sesamoiditis is defined as pain and/or inflammation under the sesamoid(s) of the hallux, in which no fracture is demonstrated by radiography or imaging. It is commonly seen in sports, especially in running and jumping athletes. It is primarily exacerbated by weightbearing, and is magnified by repetitive impact loading such as jogging, basketball, even cycling, due to a poor pedal stroke.
Etiology and diagnosis
Injuries to the hallucial sesamoids typically occur in athletes & sporting active individuals. These injuries occur most often in action sports, but are even seen commonly in golfers, and football players. The most frequently encountered problem is sesamoiditis, a diagnosis of exclusion, when no fracture is found.
The medial sesamoid typically is slightly larger than the lateral, and bears more pressure. This corresponds to the fact that sesamoiditis and sesamoid fractures are approximately twice as common in the medial than in the lateral sesamoid.
Sesamoiditis tends to be persistent and difficult to resolve because it is associated with atrophy of the underlying plantar fat pad.
Sesamoiditis is treated with mechanical measures to decrease the pressure on the sesamoids. Carbon soled shoes can transfer too much energy for some i.e. flat feet, high arch. Even a custom, molded, orthotic, with too much support vs. a soft-soled shoe; can cause an ouch. Occasionally, a stiffening device for the toe of the shoe added to both of the above. Shoes with too elevated a heel aggravate the symptoms as do extremely flat shoes, and often it is necessary to change the exercise routine (pedal stroke) to altogether eliminate weightbearing.
Even with semi weight beraring i.e. biking, having a bad routine, you can cause problems if you don't know where the cleat is to meet the foot. That is where is gets tricky!
Just because there is a horse that needs horseshoes, doesn't mean that one basic horseshoe fits all! If you don't get the horseshoe right, the horse will stay in the barn lame!
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