Q: I've been recently diagnosed with sesamoiditis. My normal dynamic sequence of standing poses and sun salutations is awkward and/or painful so I've mainly switched to a seated practice. Is there an alternative to sun salutations for warming the muscles before stretching? Are there poses that may help speed the healing in my feet and toes? Thanks in advance for any help and insight. A: Sesamoiditis is an inflammation of the tendons that surround two small bones called sesamoid bones that are located just below the base of the big toes on the balls of the feet. They are like mini kneecaps and provide pivot points for some of the tendons that move the big toe. The inflammation in this area (the “-itis”) is seen most frequently (but not exclusively) in runners, ballet dancers, and baseball catchers, and usually develops from repetitive actions that bring strong force onto the ball of the foot. It is associated with pain under the big toe at the ball of the foot, which can vary from mild aching to a more intense throbbing. One rare occasions, the small sesamoid bones can be fractured, which can slow recovery and require special treatment, so if you are having persistent pain despite ongoing treatment, it may worthwhile to see a podiatrist and request an X-ray to rule this out.
Although I am not currently aware of any studies linking yoga practices to the development of this condition, there are certainly some forms of modern yoga practice that theoretically could put you at risk for developing this. One example would be vigorous flow practices where there is repeated jumping onto the balls of the feet, such as when jumping back and forth between Standing Forward Bend and Downward-Facing Dog pose or Pushup pose (Chaturanga Dandasana). However, because I don’t know what the reader was practicing when this condition developed or whether he was engaged in other activities, such as running, that could have caused the condition, I won’t speculate on the cause of the condition. Regardless of the cause, however, I can still make some general recommendations regarding our reader’s questions.
The answer to the first question is pretty straightforward, as the key to practicing when the foot is inflamed is to do as much as you can without bearing weight on your foot, including practicing from a reclining position on the floor, seated on the floor, or seated on a chair, to take the pressure off the bottom of the foot. In all of those forms of practice, you can use your asanas to help you maintain strength and flexibility in the foot and lower leg. One way to do this is to work the muscles of your feet in a reclined pose, such as the classic version of Reclined Leg Stretch pose, where one leg is lifted up toward the ceiling. In this position, you could add in pointing and flexing your foot from your ankle, which will promote flexibility and strength in your lower leg, ankle and foot. In the same pose, with your foot parallel with the floor, you could focus on moving your toes alone by curling (flexing) and extending them dynamically, followed by static holds in each direction to work on the muscles in your feet. These two movements could be added to many other poses where your foot if free to move a bit. You can also use muscle activation in static poses that I mention below.
This is also the answer to the second question about poses that may help to speed healing of the inflamed area because taking pressure off the foot by avoiding weight bearing poses will foster healing. In general I recommend starting out by practicing only non-weight-bearing poses and as the pain in your foot improves gradually re-introducing the weight-bearing poses. Using yoga in this way can be a good adjunct to any other healing protocols you may be getting from a foot specialist.
As an example of a reclining warm-up that could take the place of Sun Salutations, you could do a combination of my reclining vinyasas that include shapes similar to Mountain pose, Arms Overhead pose, High Lunge pose (sort of), and Downward-Facing Dog Pose. For this purpose I recommend several rounds of Reclined Hip Stretch Sequence, which I also call Reclining Vinyasa 1, and several rounds of Reclining Vinyasa 2.
If you want to include some form of backbend to substitute for the Cobra or Upward-Facing Dog poses in your Sun Salutations, you can substitute Dynamic Locust pose.
And of course, I have scores of other reclined mini-vinyasas, such as this longer dynamic floor warm-up as well as seated mini vinyasas that would be good ways to warm you up for static poses that you are using to improve your flexibility in the rest of your practice. To view more of my dynamic practices, check out my Baxter Bell Yoga channel on YouTube.
To keep your leg and foot strong and flexible, while doing any static pose in the reclined position, sitting position, or chair variation add in the muscle activation technique described in Nina's post Why and How to Activate Your Muscles in Yoga Poses.
Finally, my post Yoga for Foot Pain has some more details and suggestions on moving from non-weight bearing to full weight bearing gradually as your symptoms improve.
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