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Does anyone have information on the Jones Counterstrain Technique for sesamoiditis?
Thanks,
Nick

With one hand, apply a slight distraction force to the MPJ (grip the hallux IP joint and lift). Compress the painful sesamoid with your thumb of other hand. Rotate the hallux medially and laterally to end RoM's, then dorsifles and plantarflex until find least painful position during compression of sesamoid --- hold the compression on the sesamoid in this position for a minute or so without moving and see how it feels and maybe do it again. .... it is surprising how often it works dramatically on the pain - some have called this "turning the pain off" ... then again at other times it does not work - I have not seen any consistent pattern yet.

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
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The views expressed above are those of the author and not that of La Trobe University
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I should have also added, that this whole technique does put a question mark over the diagnosis of 'sesamoiditis' (at least in my mind).

To start with, it never really is a 'sesamoiditis' (as the sesamoids do not get inflamed) - its probably really a 'peri-sesamoiditis' (as its the peri-sesamoidal structures that get inflamed). The standard treatment is to off-load the painful structures and the inflammation generally goes down and patient gets better.

Since using the Jones technique, I question the diagnosis of 'peri-sesamoiditis' and start to wonder if we are really dealing with some sort of first MPJ and/or sesamid-met head joint dysfunctions in many or some of the cases. In thoses when the Jones technique does not work, maybe it is a true 'pressure' related peri-sesmoiditis..... ... or it could be that the peri-sesamoiditis in some induce some sort of joint dysfunction that the off-loading does not address.. or

What say you?

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Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Related thread:
Advice needed re: Sesamoid pathology....Dancer

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I agree, and feel that the painful structure(s) is intra-articular rather than plantarly. I have several patients seen by previous practioners who have given plantar injections to no avail. When giving these patients intra-articular injections, they respond much better, not to mention avoiding potential fat atrophy of plantar injections. But some patients have persistent pain despite prolonged off-loading and diagnostic tests to rule out other dx. I will try this Jones technique in those cases. Any other suggestions?? Any orthotic suggestions other than a FFO with dancers' pad??
Thanks,
Nick

Firstly, ensure you have a set of radiographic images - AP and sesamoid-axial skyline view to establish whether you have a sesamoid fracture. In severe cases, where the sesamoids are intact, consider a BK Wilson's cast with the ankle (and hallux) in a 10 degree plantarflexed position for 4-6 weeks. If there is a fracture present, non-union is a common occurence so you may wish to undertake surgery to remove any fragments, although this is probably best performed after cast immobilisation. In less acute cases, ice, immobilisation, steroids and local deflective padding can be administered/applied as part of your conservative management. Functional orthoses should be considered to correct any mechanical pathology (where it occurs) as part of your long term strategy.

Mark Russell

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I have taken several courses in Applied Kinesiology, and they have a dyfunction called "holographic bone subluxation" . This is a fancy name for a bone that has been strained.
I have applied this to the foot, and have found that when this occurs in the first metatarsal, the tibial sesmoiditis results. Correction of this bone strain corrects the tibial sesmoiditis. I have been doing this for the last 10 years, and have done this on all my patients during that time with this condition. Only once it didn't work fully, and that was on a football player who was treated for the prior 4 weeks with injections and cast immobilization to no avail. He also had a weak extensor hallucis longus that was secondary to an injury of his extensor retinaculum. I corrected this also and two days later he ran for 270 yards in a football game .

Stanley

Dear All

Maybe I should stop studying and have a look more often.

Sesamoiditis is a very common problem. Moresos than you think.

Often you will only find it when you compress the bone. Watch them jump. I assume every woman who has been in arear end collision has one in their right foot and left for those who drive on the wrong side of the road!

Recently I saw a professional dancer who had seen all the gods in Sydney and was told that at 32 she was too old to dance and that she should quit!!

We have beautiful garbage specialists here. They use the old technique at the next visit, 'do you still dance?'/ The answer is 'yes' of course and then they can come back at the poor patient with "see I told you so.." instant admonishmnet for lack of knowledge.

I have yet to see this technique fail. Like Craig says, there is no constant pattern of turning off the 'Jones' Point'

For a very clear image go to my website and have a look on the bottom of the left slider called 'sesamoiditis' . This is how Jones' did it.

Regards

Musmed
www.musmed.com.au