Sesamoids are bones that are attached to and supported by tendons. They remain embedded in the muscles and provide a smooth gliding surface for the tendons to move above them. Sesamoiditis is an orthopedic condition characterized by inflammation of the tendons near two small sesamoids located in the forefoot. These bones are about the size of a corn kernel and work to support the toes while weight-bearing.
The big toe joint is the most commonly affected area in sesamoiditis, especially among runners, ballet dancers, and athletes who place repetitive stress on the forefoot.
Sesamoiditis is a type of Tendinitis and is most commonly seen in runners, baseball catchers as well as ballet dancers.
- Understanding Sesamoiditis
- Anatomy of the Foot
- Risk Factors
- Symptoms
- Diagnosis and Imaging Tests
- Treatment to Relieve Pain
- Recovery from Sesamoiditis
- Sesamoiditis Prevention
Understanding Sesamoiditis
Sesamoiditis is a condition that targets the sesamoid bones—two tiny, pea-shaped bones located just beneath the big toe joint at the ball of the foot. These small bones are unique because, unlike most bones in the body, they are not connected to other bones but are instead embedded within the tendons surrounding the big toe. The sesamoid bones play a vital role in absorbing pressure and supporting the movement of the big toe during activities like walking, running, and jumping. When repetitive stress is placed on the ball of the foot, the tendons around these bones can become inflamed, leading to pain and discomfort. This inflammation, known as sesamoiditis, often results in persistent foot pain that can make everyday activities more challenging. Understanding how sesamoiditis develops is the first step toward finding relief and protecting the health of your feet.
Anatomy of the Foot
The human foot is a marvel of engineering, made up of 26 bones that work together to provide support, balance, and mobility. Among these are the two sesamoid bones, which are found beneath the big toe joint. Unlike other bones, the sesamoid bones are embedded within the tendons that help flex and extend the big toe. This unique placement allows them to act as pulleys, improving the efficiency of the tendons and reducing friction as the toe moves. The big toe joint itself is crucial for bearing weight and propelling the body forward during physical activity. Alongside the bones, the foot contains a network of muscles, ligaments, and soft tissue that all contribute to its strength and flexibility. A healthy foot structure is essential for smooth movement and for preventing conditions like sesamoiditis, which can arise when the balance of these components is disrupted.
- Repeated movements that stress the foot such as dancing, hopping and running
- Presence of a high foot arch
- Sudden increase in the intensity of physical activity
- Acute injury, such as a sudden trauma or impact to the forefoot, can cause sesamoiditis or sesamoid fractures
- Bony feet that have less fatty layers are prone to Sesamoiditis
- Osteochondritis – Disrupted blood supply to the sesamoid bones may lead to their death and consequent deposition of calcium near these bones. This, in turn, leads to tendon inflammation
Risk Factors
Certain factors can increase your likelihood of developing sesamoiditis. Repetitive stress from activities such as running, dancing, or jumping puts extra pressure on the sesamoid bones and the ball of the foot, making athletes and active individuals more susceptible. Wearing high heels or shoes that are too tight can also contribute, as these types of footwear force the foot into unnatural positions and increase pressure on the big toe joint. People with flat feet or high arches are at greater risk, as these foot structures can alter the way weight is distributed across the foot, leading to increased strain on the sesamoid bones. Additionally, wearing shoes that lack proper support, or cushioning can make it easier to develop sesamoiditis, especially if you spend long hours on your feet. Being aware of these risk factors can help you make informed choices to protect your feet and reduce your chances of experiencing sesamoid pain.
Symptoms
Common symptoms of sesamoiditis include:
- Pain beneath the big toe joint, especially at the inner side of the ball of the foot
- Pain sets in gradually and increases if the activity is continued
- Swelling
- Redness
- Bruising
- The big toe joint may feel tender when touched
Mild cases of sesamoiditis may resolve quickly with rest and avoidance of aggravating activities. However, chronic sesamoiditis can cause persistent symptoms and may require more intensive treatment and a longer recovery period.
Diagnosis and Imaging Tests
- Diagnosis begins with a physical examination, where the doctor assesses tenderness, checks mobility, and evaluates the injured foot to distinguish sesamoiditis from other conditions.
- The passive axial compression test may be performed to help differentiate sesamoiditis from other causes of forefoot pain by assessing tenderness and inflammation in the joint.
- Imaging tests, such as X-rays, bone scans, and MRI scans, are used to assess the injured foot and specifically evaluate the medial sesamoid for fractures, bipartite structures, or inflammation.
- Magnetic resonance imaging (MRI) can detect subtle injuries, inflammation, or stress fractures around the sesamoid bones that may not be visible on X-rays, aiding in an accurate diagnosis.
- Proper diagnosis and accurate diagnosis using these methods are essential to guide effective treatment for sesamoid injuries.
In some cases, elevated uric acid levels (as seen in gout) can contribute to joint inflammation and should be considered in the differential diagnosis.
Treatment to Relieve Pain
A personalized treatment plan is essential for effectively managing sesamoiditis pain. The conservative methods of treatment for Sesamoiditis may include one or more of the following:
- The affected foot should be given sufficient rest and weight-bearing should be avoided
- Use of shoe inserts and pads for added cushioning
- Immobilization of the big toe using taping techniques or removable straps
- Cryotherapy – Application of an ice pack to the affected area at regular intervals may help to reduce swelling and reduce inflammation
- Anti-inflammatory medicines may be prescribed by the orthopedist. These treatments help reduce inflammation and swelling.
- Corticosteroids may be injected into the joint for immediate relief
- Wearing flat sole shoes or choosing supportive, cushioned footwear over high heels or other shoes that lack proper support may be helpful
- Surgical scraping of the infected tissues
- A part of the sesamoid bone or one of them may be surgically extracted
- A bone graft may be used in case of a fracture in any of the sesamoid bones
Recovery from Sesamoiditis
Recovering from sesamoiditis requires a combination of rest, gradual reintroduction of activity, and targeted therapies to restore strength and flexibility to the affected area. After the initial pain and inflammation have been managed, physical therapy often plays a key role in rehabilitation. A physical therapist may guide you through exercises designed to improve foot strength, enhance flexibility, and correct any abnormal foot mechanics that contributed to the condition. Soft tissue therapy can help reduce lingering discomfort and promote healing in the tendons surrounding the sesamoid bones. In some cases, custom orthotics or stiff-soled shoes may be recommended to provide additional support and relieve pressure on the big toe joint during recovery. The use of a short leg fracture brace may be necessary for severe cases or if a sesamoid fracture is present. Recovery time varies depending on the severity of the condition and how closely treatment recommendations are followed, but most people can expect to gradually return to pain-free activity with proper care and rehabilitation.
Sesamoiditis Prevention
Preventing sesamoiditis starts with taking proactive steps to reduce stress on the sesamoid bones and maintain overall foot health. Choosing well-fitting shoes with adequate cushioning and support is essential, especially if you have high arches or flat feet. Avoiding high heels and opting for low-heeled shoes or supportive running shoes can help distribute pressure more evenly across the foot. Incorporating custom orthotics may be beneficial for those with abnormal foot structure or a history of sesamoid problems. Regularly stretching and strengthening the muscles of the feet and lower legs can also help prevent excessive strain on the big toe joint. If you participate in activities that involve repetitive impact, such as running or dancing, be mindful of your training intensity and allow for adequate rest and recovery. By making these adjustments, you can significantly reduce your risk of developing sesamoiditis and keep your feet healthy and pain-free.
Your path to recovery starts here. Schedule an appointment with our specialized orthopedic surgeons today. Book your appointment online or call (972) 492-1334
