Sesamoiditis causes pain at the ball of the foot, beneath the big toe joint. Sesamoiditis develops when your sesamoid bones, the two very small bones located under the big toe joint, are irritated or injured. Sesamoid bones are embedded in a tendon, much like the kneecap, acting to increase the leverage of the tendons that control the big toe. Due to their location and function, sesamoid bones are subjected to massive pressure and forces every time the big toe is used to push the foot forward.
The symptoms of sesamoiditis tend to worsen gradually. What might start as a mild ache, can quickly increase to an intense throbbing. As the severity increases, it can become difficult to put any weight on the big toe or walk comfortably. You may also notice swelling or redness around the big toe joint, and pain when trying to bend the toe upwards.
Injuries to the sesamoid bones can range from mild irritation to a fracture (or break). It’s important to seek treatment early, to help prevent the problem and pain from worsening.
Who suffers from sesamoiditis?
While anyone can develop sesamoiditis, those participating in activities that involve repetitive loading of the ball of the foot such as in dancing, sprinting or even walking, are more likely to suffer from this condition. People with prominent foot bones, higher arched feet, markedly flat feet or those who tend to run on the ball of their foot also tend to be more prone to sesamoiditis.
Treatment is very specific to the person and the symptoms they’re experiencing, but usually starts with helping to settle the painful symptoms. This is done through alleviating pressure away from the sesamoid bones using padding, strapping, or orthotics, as well as using ice, oral anti-inflammatories, and temporarily stopping the activity that’s causing the pain.
From here, the goal is to help heal the damaged bones and surrounding tissues, while treating any contributing factors to help prevent the problem from coming back in the future. We often use a combination of full-length custom orthotics with supportive footwear to achieve this. The orthotic is designed in a way that deflects pressure away from the big toe joint, instead redistributing the pressure over the lesser toes at the ball of the foot. Orthotics can also help address contributing factors like flat feet (pes planus), high arched feet (pes cavus), bunions or those with reduced plantar fat padding. In the case of persistent severe sesamoiditis or stress fractures of the sesamoids, the use of a short leg pneumatic walker with rocker sole (walking cast) for 2 to 6 weeks may be required. Failing this, an injection of steroids or surgery may be considered.
In severe cases or following a true fracture of the sesamoids, surgery may be required to remove the damaged or fragmented sesamoid bone. In some cases, due to reduced blood supply, there may be delayed or absent healing and a surgical review is warranted.
Most individuals will have an immediate improvement in symptoms once the pressure is removed from the sesamoids using orthotics and deflective padding. If there are no complications, complete resolution can be achieved within months.