Sesamoiditis is an inflammatory condition affecting the small bones beneath the big toe joint, frequently causing localized forefoot pain, especially among active individuals. Athletic taping offers a non-invasive, mechanical solution designed to alleviate pressure on the affected area. This guide provides a detailed, step-by-step approach to applying the most effective offloading tape technique for temporary symptom management.
Understanding Sesamoiditis
Sesamoiditis involves the inflammation of the two small, pea-shaped bones (sesamoids) located on the underside of the first metatarsophalangeal (MTP) joint, or the big toe joint. These bones are embedded within the flexor hallucis brevis tendon, acting like a kneecap to provide mechanical advantage and absorb impact forces during movement.
Pain results from repetitive strain or trauma that increases pressure and loading on the sesamoid bones and surrounding tendons. Because the forefoot bears substantial weight, especially during the “toe-off” phase of gait, excessive force causes irritation. This chronic pressure leads to inflammation, manifesting as dull pain directly beneath the big toe joint that worsens with weight-bearing activities.
The goal of taping is to mechanically reduce pressure on these inflamed structures. By manipulating the tissue and joint position, taping effectively “offloads” the area, limiting painful movement of the big toe joint. This reduction in strain allows the irritated tendons and bones to rest, facilitating the healing process.
Supplies and Foot Preparation
Effective sesamoiditis taping requires specialized materials to ensure support and skin integrity.
Supplies Needed
You will need a roll of rigid athletic tape (half-inch or one-inch width), medical scissors, and pre-wrap or underwrap to protect the skin from adhesive. A skin-adherent spray can also be used to improve the tape’s longevity, especially for active users.
Foot Preparation
Before applying materials, the foot must be thoroughly cleaned and dried to maximize tape adherence and prevent skin irritation. Remove any lotions, oils, or excessive moisture from the ball of the foot and the big toe area. The foot should be positioned comfortably, ideally with the ankle in a neutral position and the big toe slightly relaxed downward (plantarflexed) to take tension off the sesamoids.
Detailed Taping Application
The most common and effective method is the offloading technique, which creates a rigid support structure to physically redistribute weight away from the painful area.
Applying Pre-Wrap and Anchors
Begin by applying pre-wrap around the foot to cover the entire area where the tape will be applied, extending from the mid-arch to past the big toe joint. Ensure no wrinkles or creases are present.
Next, establish the anchor points. Cut a strip of rigid tape long enough to wrap around the mid-foot, just behind the ball of the foot, applying it firmly but without restricting circulation. Place a second, shorter anchor strip around the big toe, just below the toenail, avoiding excessive tightness.
Creating the Offloading Lift
The core of the technique involves the support strips that create the lift. Measure a strip of tape long enough to span from the big toe anchor, under the foot, and up to the mid-foot anchor. This strip gently pulls the big toe into a slightly downward (plantarflexed) position.
Apply the tape with a moderate pull (approximately 50% tension) down the top of the big toe, under the MTP joint, and up the arch, securing it to the mid-foot anchor. Repeat this process with two or three overlapping strips, fanning them slightly toward the inner and outer edges of the MTP joint to create a wider supporting beam.
The tension in these strips should mechanically lift the skin and soft tissue, aiming to relieve direct pressure on the sesamoid bones during weight bearing. To enhance the offloading effect, you can incorporate a felt or foam dancer’s pad with a cutout for the painful sesamoid, placing it directly over the pre-wrap before applying the final tape layers.
Securing and Testing
After applying the tension strips, apply a final layer of tape, known as a closing strip, around the mid-foot anchor to secure all loose ends. This final wrap ensures the support strips remain in place and prevents peeling during activity. Gently press and smooth all layers of tape to activate the adhesive and ensure a flush fit.
Immediately test the application by standing and taking a few steps to confirm a noticeable reduction in pain without new discomfort or excessive pressure. If the technique is correct, the weight should feel shifted away from the ball of the foot and more toward the heel or mid-arch. Adjustments can be made by carefully removing and reapplying the tension strips until the desired pressure relief is achieved.
Post-Taping Care and Monitoring
After taping, careful monitoring is necessary to ensure the technique is safe and effective. The tape should feel supportive and should not cause new pain, numbness, or tingling. Throbbing, discoloration, or a feeling of excessive pressure are signs the tape is too tight and must be immediately removed and reapplied with less tension.
Athletic tape is typically worn for one to three days, depending on activity level and integrity, but should be removed immediately if it becomes wet or loose. Remove the tape slowly, pulling gently in the direction of hair growth to minimize skin irritation. A specialized adhesive remover can be used to dissolve sticky residue, which is often gentler than aggressive peeling.
Taping is a temporary measure and should be used as part of a broader treatment plan that includes rest and appropriate footwear modifications. If pain worsens, symptoms persist beyond a few weeks of conservative care, or if signs of infection (like increased redness, swelling, or warmth) appear, professional medical consultation is necessary. Consult a podiatrist or physician to rule out more serious issues, such as a sesamoid fracture, which requires different management.