Sesamoid Fractures: Part 6 (Individualizing Orthotic Care)

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  Richard Blake Admin KRM team

  4/15/25, 9:11 AM

  

   

  In our discussions on sesamoid care, there were some general rules discussed concerning orthotic therapy. These rules are:

  • With the use of a dancer’s pad (reverse Morton’s Extension), the sesamoid area can have a degree of off loading
  • When there is some heel valgus, which can overload the medial column, there should be some varus corrections made
  • Any lateral forefoot loading possible is helpful to spread forefoot weight away from the first metatarsal head (forefoot valgus balancing when indicated, Richie Wedgies or valgus onlays, metatarsal pads, proximal medial arch support to shift weight lateral)

   

  Therefore, these are 5 must-dos in sesamoid care:

  1. Dancer’s padding
     
  2. Varus any heel valgus
  3. Fully support any forefoot valgus
  4. Metatarsal pads
  5. Valgus onlays

   

        When we individualize this further, a few more points surface. These include:

  • Use the plastic thickness based on the weight of the patient
  • Frame Fill is only important here when you can not use the ideal thickness mentioned above (I like this to be Rigid)
  • Normal Balancing of Forefoot Deformities
  • The above Dancer’s padding should be sulcus length in dress shoes and full length in athletic shoes where there is no room
  • Arch Fill should be 1.5 mm
  • Pronators with heel valgus
  • Rearfoot post extrinsic and zero degree motion 
  • Some form of heel inversion (medial Kirby Skive, Inverted Technique, RF and FF varus Posts: Rearfoot Varus Extrinsic, Varus Extrinsic Bar, Heel skive)
  • Rigid feet needing cushioning

   

   

  • You can make C type orthotics sulcus or full length either with EVA or Plastazote as the base with cut out for the first met head and hallux built in  
    What is a Shock Absorption Orthosis? Part 1
    What is a Shock Absorption Orthosis? Part 2
    What is a Shock Absorption Orthosis? Part 3
    What is a Shock Absorption Orthosis? Part 4

   

   

  Some general rules: 

  • PFFRs always need dancer’s padding and metatarsal padding
  • Remember to remove dancer’s padding after injury subsides if not PFFR (plantar flexed first ray)
  • Pes Cavus always needs dancer’s padding and metatarsal padding (always even in shoes without orthosis)
  • If you find FHL (Functional Hallux LImitus) always use dancer’s padding, metatarsal padding, zero motion rearfoot posts
  • With many cases of FHL, consider S type orthoses  (Sagittal Plane Device, Part 2)
  • I love for everyone to measure RCSP. If everted, consider P orthoses
    What is the Pronation Orthosis? Part 1
    What is the Pronation Orthosis? Part 2
    What is the Pronation Orthosis? Part 3
    What is the Pronation Orthosis? Part 4
    What is the Pronation Orthosis? Part 5
    What is the Pronation Orthosis? Part 6
    
       
  • When the Achilles Tendon is tight, due to the increased metatarsal plantargrade forces, consider a good stretching program and perhaps the temporary use of bilateral heel lifts of 2 to 4 mm 
  • When you are aware of asymmetries, try to treat both sides asymmetrically

  
  
  

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