09 Jan Sesamoiditis
Sesamoid bones are bones within tendons that have no direct attachment to another bone with a joint. We have two sesamoid bones under the joint at the base of the big toes. When they become inflamed, the condition is called sesamoiditis.
Causes of sesamoiditis include acute injury or chronic overuse. Sesamoids can also have stress fractures of the sesamoid or even osteonecrosis. Sesamoids can be infected or be involved in a systemic inflammatory disorder.
Sesamoiditis can be detected by a careful history and examination. It typically causes pain under the big toe that worsens on weight-bearing, when pressure is applied directly to the sesamoid bones, or when the great toe is forcefully pulled upwards. Sesamoid fractures cause acute, severe pain, but sesamoiditis causes slow onset pain that worsens gradually. Sesamoiditis may also cause bruising, problems straightening or bending the big toe, and swelling. The discomfort caused by sesamoiditis can result in a limp as the patient shifts his/her weight to the other foot to alleviate the extra pressure and pain.
Diagnosis can be confirmed on plain x-rays, especially if a fracture of the sesamoid bone is suspected. But it can be hard to visualize sesamoid bones given their small size. An MRI study or a bone scan can also be effective to identify sesamoiditis as well.
The treatment for sesamoiditis is mostly conservative. Wearing shoes with extra cushioning can help relieve pressure on the affected sesamoid. Specific inserts or custom orthotics also help. One should avoid limit activities during active inflammation. In some cases, a doctor may tape the large toe in a slightly downward manner to stretch and relieve pressure on the toes or a special leg fracture brace can be worn for the same effect. Symptomatic relief may be achieved with non-steroidal anti-inflammatory medications and ice application. Corticosteroid injection may be administered to reduce inflammation in the tendons. It can take up to 6 weeks for at-home treatments to relieve pain associated with sesamoiditis.
If symptoms continue or worsen, a stress fracture may have occurred. If this has happened, a person should not put any weight on their foot for about 6 weeks.
In rare instances, a doctor may recommend surgery to treat a sesamoid injury or fracture. A person will need to see a foot and ankle surgeon who will determine if surgery is necessary. If conservative management fails, surgery may be considered but of the big toe can happen as a result of removing one or both of the sesamoid bones.
Sesamoid injuries can take longer to heal and can be very painful and productivity-limiting. Recovery time is even longer in athletes who may take up to 3 to 6 months to return to professional sports. Because it can sometimes occur due to overpronation, runners or athletes may benefit from coaching on how to reduce stress on the foot joints. This includes practicing the midfoot strike in a running stride, which involves taking shorter strides and focusing on the middle of the foot.