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Sesamoiditis – Pain In The Foot!

What is a sesamoid bone?

A sesamoid bone is a bone embedded in a tendon. Most bones in the human body are connected to each other at joints. But sesamoid bones are the ones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. In the foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.

Sesamoids act like pulleys by providing a smooth surface over which the tendons slide. The sesamoids in the forefoot also assist with weightbearing and absorbing the weight placed on the ball of the foot when walking, running and jumping.

What causes sesamoiditis?

Sesamoids, like any other bones in our body, can fracture. The tendons that surround the sesamoid bones can also become irritated and inflammed and this is termed as sesamoiditis, a type of tendinitis.

Sesamoiditis is caused by increased pressure to the sesamoids and are associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet.

The sesamoid bones are commonly injured dancers, particularly in those who fail to perform a plié on landing, absorbing the energy of the landing through partially flexed knees. Without such absorption built into a dancer’s technique, sudden deceleration with high impact of the sesamoid bones predisposes to injury.

Persons with a low arch or high-arched foot or a prominent joint can be predisposed to sesamoid damage/injury. Ill fitting shoes or shoes with a higher heel can all increase stress to the sesamoid area.

 

Symptoms

• Dull pain beneath the great toe on the ball of the foot
  
• There may be some redness and/ or swelling beneath the great toe joint
• There may be stiffness in moving the joint
• Difficulty when in shoes
• Difficulty in walking

 

Treatment: Non-surgical Approach

• Stop the activity causing the pain.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to reduce pain and inflammation.
• Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
• Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
• A felt pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
• Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet.
• Your doctor may recommend an injection of a steroid medication to reduce swelling.
• Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.
• If symptoms persist, you may need to wear a removable walking cast for 4 to 6 weeks.

 

Treatment: Surgical Approach

Surgery is indicated mainly for the most severe sesamoid injuries with symptoms persisting for at least 6 months following initial treatment. In such cases, the surgeon will determine the type of procedure that is best suited to the individual patient.