Thursday, July 13, 2017

Sesamoiditis Question for Clyde from Patrick / NYC

Hello Clyde , I have a question for you. I sustained a sesamoid injury in both feet last year as a result of doing squats with heavy weights in barefeet (very stupid). MRI and xrays do not show fractures. The diagnosis is inflammation of the sesamoid area/big toe joint. I've been experimenting with various types shoes and inserts (i.e. wide forefoot, stiff sole, rocker bottom, certain combinations thereof as it is not easy to find). 

I have a couple of questions about your XL Blades because I am trying to figure out how they differ from other carbon fiber inserts that I have purchases, such as from Return To Play, and

I hope you do not mind indulging me.

One of the problems I have with the plates I've tried is they are so unforgiving. Stiffness is the goal, yes, but I have noticed that with this injury, I get a lot of stinging in the underside of the great toe joint especially when coming into contact with hard surfaces such as uncarpeted floor in barefoot (which I try not to do). I have placed carbon inserts into my shoes and used off-weighting materials like dancers pads, and cut holes in the insoles that sit on top of the carbon plate, but I still notice that when I walk and turn certain ways, depending on the shoe I am in, my foot "catches" on the plate in the sesamoid area and creates a sudden jolt of stinging. I have noticed in pictures of your plate that the big toe area seems to be depressed, it hangs a bit lower than the surface of the rest of the plate. Is that done so that the 1st metatarsal area is off-weighted even more and to prevent pressure from the carbon insert hitting the bottom of the toe joint like I have experienced? The other carbon inserts I have do not have that depressed area, so it makes me wonder if yours would work better.

The other questions I have is related to how I have trouble finding shoes that actually allow for the carbon plates to sit in. A lot of shoes do not have a flat surface/footbed area, so a flat stiff insert doesn't sit flat, it sort of bounces around since it is not coming into contact with the full surface of the footbed. I have a pair of New Balance 928 Walking shoes and they have a flat footbed on the inside, so the insert seems to work well in those, whereas in many shoes, especially something like an Oxford (like I need for the office), they do not, since there is curvature in the footbed in many Oxfords. I was wondering if that made sense to you, and if in your experience you have found that certain types of shoes work with your inserts better. I am guess also that with the stiffness, a rocker sole is going to make a more comfortable insert, since without the rocker, it is difficult to walk with a stiff insert. The challenge is also extra-depth, since adding the inserts underneath an existing insole and any additional padding makes for a very tightly packed shoe. That's a challenge I've had with other carbon inserts.  Extra depth, WITH a flat internal footbed, are not easy to find.

Anyway, if you would kindly consider my concerns as I determine whether or not it would be worthwhile for me to pursue your XL Blade, I would greatly appreciate it. It's been quite a challenge, and I"m sure you have heard these concerns from other clients. I have great respect for your field.

Thank you very much

Patrick M.
New York City

Hello Patrick, Thanks for the question.

All my X1 Blade structural designs are tailored to specific applications (sesamoiditis being one) using a combination of mediums: composites (carbon fibers both bidirectional and unidirectional and glass),  a unique low coefficient of friction film, and compression resistant polyethalene foams. Unlike a "carbon fiber plate" that is uniform in density and stiffness (like a rigid dinner plate) the X1 Blade orthotic varies in density and flexibilty. We achieve this by varying the fiber orientations along the laminate structure in three zones - rear, mid, and forefoot. This variable design allows for a more natural foot motion.

1) 3 Flex Zones (TriFlex) - 1) Rearfoot  -fexible and padded for heel strike 2) Midfoot - flexible so as

X1 Blade for Sesamoiditis
not to restrict ankle motion during activity 3) Forefoot - stiff minus with a 2mm drop under great toe lined with low friction film (ShearBan).
2) Rocker Shape to encourage a more natural gait and fit the curvature of a standard shoe shape. A flat "carbon fiber plate" is only good for children who are toe-walkers. It will to get them into a more natural heel toe toe gait. As you have found it is very difficult to walk normally with a stiff flat "carbon fiber plate" in your shoe. There is a biomechanical reason for that!
3) Medial Toe Wedge - The 2mm drop under the great toe creates a 1mm medial wedge that shifts some of the ground force off the 1st MTP (sesamoids) to the 2 through 5 met heads during weight-bearing.
4) 2mm poyethalene foam (compression resistant) - added to forefoot zone to shift more ground force from 1st MTP to mets 2 through 5.
5) Specs: Weight: Usually 1+ ounce depending on the shoe size.  Thinness: from 1mm to 2mm in thinness depending on the flexibility zone.

The shoe issue. What I say is:  if you decide to order an X1 Blade for your sesamoiditis when you get it try it without an insert in the shoe to see if it will work for you and if so deal with the shoe issue last.

Patrick, I have made several of these  X1 Blades for sesamoiditis (usually for athletes) with a 100% money back satisfaction guarantee, and so far I have never gotten one back. 
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So I would say give it a try! 

Clyde Peach, CO