Keys To Patient Education On Bilateral Sesamoid Pain And ‘Snapping’ Peroneal Tendons

A patient contacted me after experiencing bilateral sesamoid pain after an ankle sprain. He did physical therapy for a month but still has the same pain level.

He sought a second opinion from a foot and ankle surgeon, who found the outer sesamoid bone is tender on his right foot and both sesamoids are tender on the left foot. His peroneal tendons are “snapping” over the bone slightly on the left side and while the intensity of the snapping motion has decreased slightly over time, he is having a lot of pain in the area of the tendons and all the way up through the muscles of the leg. The doctor had the patient wear a controlled ankle motion (CAM) boot on the left side.

Patients who irritate the peroneal tendons sometimes abnormally supinate away from their sore sesamoids and begin to feel snapping as the tendons get tight from overuse. The motion of two abnormally tight tendons causes the snapping sound. This patient should not supinate abnormally and ice the area twice daily to remove some of the inflammation.

What can this patient do to maintain strength while he is wearing the CAM boot? At this point, this patient is trying to relax the tendons, not strengthen them. Standing flat for balance should be okay for two or three minutes twice daily. The tendons are irritated in different ways when the ankle is pointed or flexed too much. The most important rehabilitation would be cross training with stationary bike riding if available. Patients usually can lower the seat enough to facilitate less strain on the tendons.

To stay comfortable in the boot, the patient should continue to utilize Neuro-Eze (Foot Express/Angsko), gentle massage, contrast bathing and nerve flossing. These will help the nerves. Patients who are wearing a boot might want to get an Evenup (Evenup Corp.) shoe balancer for the other limb to balance the hip height with adequate shoe height. That will protect the spine.
 

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2018/10/snapping-peroneal-tendons-and-nerve.html. It is reprinted with permission from the author.