What is sesamoiditis?
Sesamoids are bones that are connected to muscles by tendons. They differ from most bones in the body, which are connected to each other at joints. Sesamoiditis occurs when the tendons attached to sesamoids become inflamed.
The kneecap or patella is the largest sesamoid in your body. There are two more, much smaller sesamoids on the bottom of your foot near the big toe. Sesamoiditis usually refers to inflammation of the tendons in the foot, not the knee. Inflammation of the two tendons attached to the patella — patellar tendon and quadriceps tendon — is usually categorized as tendinitis.
Sesamoiditis is especially common among certain types of athletes and dancers. The condition usually stems from straining or overworking the tendons. Sesamoiditis is usually treatable with rest and anti-inflammatory medications. Keep reading to learn more.
What are the symptoms?
The main symptom of sesamoiditis is pain that develops under the ball of the foot. The pain tends to build gradually, and you may notice some swelling or bruising.
Sesamoiditis can make it difficult to straighten or bend your big toe. It may even hurt to move that toe. You may also have a “pop” sensation in your big toe when you walk.
What causes this condition and who’s at risk?
Sesamoiditis usually results from the overuse of the tendons involved with the small bones in the front of the foot. The tendons also can become inflamed if they experience repeated trauma, such as wearing high heels or shoes that fit poorly.
If you engage in sports and activities that require a lot of pressure be placed on the ball of the foot, you’re at a higher risk. Running, basketball, and ballet are just a few activities associated with sesamoiditis.
How is this diagnosed?
Diagnosing sesamoiditis starts with a physical examination of the foot. Your doctor will check for tenderness around the ball of the foot and move your toe in different directions. The limits on your toe’s flexibility and your pain level will help your doctor diagnose your condition.
If sesamoiditis or a foot fracture is suspected, your doctor will recommend that you get an X-ray of your foot. Sesamoids typically have smooth edges, so a jagged edge may be a sign of fracture. Your doctor may have both feet X-rayed to compare the bone structure in each.
In some cases, a bone scan may be necessary to make a diagnosis. This is a special imaging test that uses a small amount of radioactive dye to help diagnose any underlying problems. It can provide details that don’t always show up on an X-ray.
Your doctor may also use an ultrasound or MRI to help diagnose injuries to tendons and soft tissue.
What treatment options are available?
Sesamoiditis typically doesn’t require surgery or other intervention. Most treatment plans focus on lifestyle changes and pain relief.
The first step is to stop whatever activity may be causing sesamoiditis. It’s also important to avoid other activities that put extra pressure on the ball of your foot. You should also elevate your foot and ice it.
If high heels or other shoes are pressuring the sesamoids, you should avoid them and opt for more supportive and comfortable footwear. Soft-sole and low-heeled shoes are best. Clogs and other stiff-soled shoes may also be comfortable.
Medication and orthotics
Orthotics, such as padded insoles for your shoes, may also be beneficial. In mild cases, you may be able to use an over-the-counter orthotic insole. There are also orthotics that are customized for your foot. A well-made orthotic insole should last a year or so.
Sometimes taping the big toe to the toe next to it can ease symptoms. The toes should be pointed slightly downward. Ask your doctor or a nurse about how to do this yourself.
If other methods aren’t successful, surgical removal of one sesamoid bone may be necessary. It’s best to only remove one of the two sesamoids. If both are taken out, it can have a damaging effect on the big toe. It will no longer line up in a healthy manner.
During the surgery, you will be placed under general anesthesia. Your surgeon will make an incision on the bottom of your foot and then separate the soft tissue around the affected bone. They’ll be careful not to damage the nerve that runs along the bone. After the bone is removed, the soft tissue is put back in place, and the incision is closed up. The location of the incision will depend on which sesamoid is being removed.
Mild cases of sesamoiditis resolve within a few days with rest, ice, and anti-inflammatory medications. Some bouts of sesamoiditis may take longer to heal. If symptoms don’t fade within a week or so, your doctor may recommend that you wear a removable, short leg brace.
Once symptoms disappear, you should be able to resume normal activities. You may need to avoid running and jumping for a while, even after the pain goes away. You should talk with your doctor about how and when to return to sports, dancing, and other activities that put extra strain on the ball of your foot.
The key to a healthy recovery is to keep the pressure off your sesamoids. If cramped shoes may have been the problem, then the longer you can stay out of the guilty footwear, the faster you’ll recover.
Tips for prevention
There are some steps you can take lower your chances of developing sesamoiditis:
- Wear sensible shoes, such as sneakers. They should have a wide toe box so your toes aren’t cramped.
- Use orthotic insoles, especially if you’re in a job that requires a lot of heavy lifting, crouching, and other activities that put pressure on the ball of your foot.
- Replace running shoes or other sneakers regularly. The cushioning to support your feet wears out over time, which can put your soles at risk.