SesamoiditisOct 14, 2022
Sesamoiditis is an overuse injury that causes pain in the ball of the foot and specifically under the big toe joint.
The sesamoid bones are very small bones that are located under the big toe joint. They are similar in appearance to tiny kneecap bones and similarly, their job is to act like small pulleys and help the big toe joint and attached tendons to it, to move in a controlled manner when moving and weight-bear. Therefore, sesamoids bones can take an incredible amount of pressure, and force with every step we take and can put these bones at risk for developing injury and inflammation, thus pain.
Who are at risk?
People participating in activities and sports that involve repetitive, excessive loading of the ball of the foot such as dancing, sprinting, or even walking often suffer from this condition. People with bony, higher arched feet, marked flat feet, or those who tend to run on the ball of their foot also tend to be more prone to sesamoiditis.
The pain may be constant or it may occur with, or be aggravated by, movement of the big toe joint. It may be accompanied by swelling throughout the bottom of the forefoot.
What does Sesamoiditis pain feel like?
Sesamoiditis pain is often associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes and/or aggravated by specific weight-bearing activities.
Pain is focused beneath the big toe joint around the ball of the foot and most common when bending or straightening the big toe. As sesamoiditis is a chronic condition, pain can be gradual with some swelling or bruising, however, if a sesamoid fracture is present, the pain will usually be felt immediately.
How is Sesamoiditis diagnosed?
To diagnose a sesamoid injury, the Podiatrist will need to physically examine your foot, with a particular focus on the region of the big toe joint. Your assessment will have a hands-on approach to test for joint range of motion, gait analysis and footwear patterns are all important considerations.
Conditions causing similar discomfort to sesamoiditis can include turf toe and sesamoid fracture (break). Turf toe is an injury to the soft tissue surrounding the big toe joint and usually occurs when the big toe joint is extended beyond its normal range. A fracture (break) in a sesamoid bone can be caused by direct trauma or impact to the joint.
So, there are a number of forefoot pathologies that can present similarly to sesamoiditis, therefore identifying the particular cause and confirming the diagnosis of sesamoid pain is important to ensure the correct treatment. X-rays may be needed and other advanced modern imaging techniques may need to be considered.
Treatment for sesamoiditis
Treatment is usually non-surgical to start with and can include one or more of the following:
- Immediate immobilisation of the joint
- R.I.C.E – Rest / Ice / Compression / Elevation
- Footwear change: use of modified shoes that have reduced flexion at the forefoot, specifically the big toe joint
- Sesamoiditis Taping & Padding – a specific sesamoiditis pad and/or strapping can be used to relieve tension or load in the forefoot
- Orthotic Devices – sesamoiditis orthotics are specifically designed to reduce the load on the injured sesamoids in an effort to relieve pain and promote healing and prevent reoccurrence
- Oral non-steroidal anti-inflammatory drugs may be used as a temporary measure
- Steroid Injections – in some cases can be used to reduce pain and inflammation.
Sesamoiditis surgery is usually only considered if other treatment methods are unsuccessful. Your podiatrist can help to explain your surgical options if required and provide guidance on referral to the best-trained surgeons for this procedure.
Most patients will have immediate improvement in symptoms with conservative care and ongoing management may be recommended in those with an underlying foot condition.
Consult a podiatrist that understands the various causes and treatment options for sesamoiditis. This will help to ensure a more rapid recovery.
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