Disclaimer: Don’t take this blog post as a substitute for a professional doctor’s or podiatrist’s diagnosis. I am neither of those things. I am simply narrating my own anecdotal experience. Use this information at your own risk.
Almost exactly a year after I had suffered my first ever bout of sesamoiditis, I succumbed to it a second time.
This time around, I couldn’t put all the blame incorrect cleat positioning like I had previously, although addressing that certainly helped my on-the-bike comfort and I’ll mention it later. Now, it was down to a couple of more insidious things.
On the Sunday the ball of my left foot – aka the first metatarsophalangeal, or “MTP,” joint – started to flare up with pain, I had capped off a pretty grueling final week of August on the indoor trainer, complete with two earlier FTP test attempts and what I thought was a relatively easy session around Wahoo RGT‘s Pienza hill loop that morning. What appeared to be “enough” rest turned out insufficient, as the familiar pain got worse and forced me to hobble around loading the outside of my left foot with my body weight for at least ten days. Weighting up the ball of my left foot meant having to flex my big toe forward to push off, which is exactly the kind of motion I had overused, and led to this situation.
This kind of overuse is much more egregious because I was spending so much time on the trainer. It can be argued that trainer mileage is harder than outdoor mileage simply because most of the time you can’t coast or freewheel – you have to keep pedaling.
The final week of August, I noticed the old 700C x 28 mm slick tire I used for trainer duty had started deteriorating into a fine black powder dusting the floor of my training room, signaling that it had had one too many heat cycles pressed against my Wahoo KICKR SNAP‘s resistance unit. Tucked away in my spares drawer was a Continental Hometrainer tire specifically made for indoor trainer use; the German company will warn you that it is not supposed to be used outdoors.
I thought it was about time I put it to use.
There was a catch. The Hometrainer rubber I had installed onto my wheel was a 700C x 32 mm size, and I blindly kept pedaling through the same cogs without accounting for the larger tire. Since my training wheel now had a slightly larger external circumference, I really should have shifted to easier gears to compensate. The effective gearing difference was enough to bludgeon my MTP sesamoid bones and tendons within two or three rides.
The day I succumbed to sesamoiditis, I distinctly remember I was pedaling without the Ergon x Solestar IP3 insoles in my Specialized S-Works 6 XCs. This meant that I was pronating my left foot (i.e. turning it inwards), generating big point-loads on its MTP joint. While the S-Works 6 XCs have sole and arch support baked into their stiff midsoles, apparently it wasn’t enough, and the insoles gave this back in such a way that my sesamoid bones could receive less weight.
RECOVERY AND TWEAKS FOR PREVENTION
All in, it took me about 16 days to properly recover – mainly involving rest and being off my feet. While I did an exploratory indoor trainer session on day 11, I pushed every left pedal stroke with a bit of trepidation. I was feeling out how solid my left foot was, wattage be damned. That ride was okay but still felt somewhat wonky. My second indoor trainer ride on day 16 felt much better.
As of this writing, I’ve been slowly progressing with the time, distance, and ride intensity I spend on the saddle, taking care not to overdo it at the same time. I’ve successfully done two-hour stints riding Wahoo RGT’s Borrego Springs flat time trial course, each covering at least 50 km, and I haven’t had sesamoiditis flareups yet.
At the same time, I studied how I could continue riding while avoiding another flareup of sesamoiditis in the future – especially in the middle of my second 200 km audax attempt. Based on medical resources I dug up, it seemed I was on the right track in consciously reprogramming my left foot’s loading pattern, supinating (i.e. shifting weight to the outer edge of the foot) to make up for my relatively flat feet, and minimizing big toe movement. That said, over-supination isn’t good either as it can lead to another type of pain.
Two days before resuming my indoor cycling, I dismounted the Hometrainer rubber and replaced it with my old pair of Continental Grand Prix tubed clincher tires, returning to the familiar 700C x 28 mm size. I was hoping not to do this, as I wanted these tires as a backup in case my foray into tubeless didn’t work out. Then again, I suppose I’ve already had seven months of relatively pain-free tubeless tire ownership, so I might as well.
I combined the use of the Ergon IP3s with moving my cleats as far back as I could to further unweight the sesamoids. These tweaks worked, even on my less-stiff Fizik Terra Powerstrap X4s. My insoles are still in decent condition on their fourth year of service, but I’m getting another pair of the next-level-stiffer Tour or Kontrol insoles in the future so that both pairs of my cycling shoes have them.
Off the bike, recovery came in a surprising package: Birkenstock’s Arizona sandals. I bought them enticed by reports of their longevity, sustainability, and cobbler-friendliness. As it turns out, they are perfect for sesamoiditis recovery and redistributing the loads on my feet – much better than plain flip-flops, because their signature shaped footbed prevents foot pronation. I enjoyed my pair so much, I got another pair a week later.
If this second brush with sesamoiditis has taught me anything, it’s that this is fundamentally going to be an ongoing cycle of management and rest alongside my riding and training, because it can strike again. Perhaps some of it is also due to age, as I’m not getting any younger either. Riding big distances on my bike injury-free need not be impossible – it just has to be approached smartly.