Sesamoiditis is inflammation of one of two small bones located in the foot called the sesamoids. Everyone has these two small bones. These bones appear underneath the big toe joint on the bottom of the foot. The actual location of these two bones is underneath the head of the first metatarsal bone, which is actually the base portion of the big toe.
These particular bones have a very important anatomical role in helping to distribute pressure and stress across the first metatarsal as one walks. These structures can become injured in a wide variety of ways. It’s very common for runners to develop sesamoiditis due to the constant pounding and joint motion that occurs at this site. It’s also common for people with repetitive type activities such as jumping off of platforms, climbing on ladders, using heavy pedals, other sorts of things which can create direct pressure to the sesamoids themselves. Certain injuries can also result in sesamoiditis, including injuries that force the big toe joint either upward or downwards, which causes stress and strain to one of those sesamoid bones.
The symptoms of sesamoiditis can vary. Most often the symptom is a sharp pain that’s located directly underneath the big toe joint on the bottom of the foot. It can also sometimes present simply as a dull ache, or just simply a feeling of pain or discomfort that’s not very describable. Mostly this is felt when one is walking on their foot and is usually felt more so when one is barefoot rather than wearing shoes, or at least when they’re wearing supportive shoes. It could also be felt a little more strongly when one is wearing something less supportive like flip-flop or sandals for instance.
Sesamoiditis is a condition that’s not too difficult to treat when caught in its earlier stages. Basically, treatment involves trying to reduce the actual direct pressure to the bottom of the foot, to reduce direct strain on the sesamoid bone, to allow essentially the inflammation within the bone itself to heal. This can be accomplished through a number of different means which can include simple padding that will take weight away from the sesamoid area, all the way on up to an orthotic, which helps to redistribute pressure across the ball of the foot. Even sometimes the use of a pneumatic walking boot, which actually takes away the majority of the pressure that is underneath the big toe joint during the walking cycle and when one actually places weight on their foot. More advanced cases sometimes would actually need to be immobilized in a cast with the use of crutches to support the foot, but I don’t see this too frequently, or at least the need for immobilization is not too frequent in most of these cases.
Sesamoiditis also can be treated with anti-inflammatory medication to try to actively reduce the inflammation. This can include non-steroidal anti-inflammatory medication, either over the counter or prescription, and also includes techniques such as icing, which will help to reduce the inflammation as well. Occasionally we have to inject a steroid compound into that region to try to decrease the inflammation of the sesamoid when other techniques aren’t working as well. However, one must be careful because if a stressed fracture, or a stress reaction is present in the sesamoid bone, this can actually make things a little bit worse with the use of steroid medication. That can actually decrease the ability for those types of injuries to be able to heal properly. Use of steroid medication is not the best idea if that’s a concern.
When one gets rid of their sesamoiditis, certainly there is the potential for that condition to return again if the chronic activity is still going to take place. Therefore, sometimes special consideration needs to be made towards either reducing one’s activity which is creating the inflammation in the first place, or simply being more careful such as using more supportive shoes, better shock absorption underneath the sesamoid area, and also using an orthotic insert to help decrease the strain to the bottom of the big toe joint, which can help to decrease the pressure to the sesamoid area.
When conservative treatment techniques do not work and pain continues to be present due to sesamoiditis and the condition, you’re not going to wait with immobilizing the foot or reducing the pressure to the sesamoid, or using medication and anti-inflammatory techniques, then more aggressive means need to be taken in order to get rid of the pain. Sesamoiditis can become a rather chronic and debilitating condition if it’s not resolved. The more aggressive way of treating this is essentially to remove the sesamoid bone that’s inflamed through surgery. In general, this relieves all the pain and it basically leads one to not have anymore symptoms. However, removing a sesamoid can place a moderate risk to the big toe joint of some instability.
The sesamoids do have a role in the stability of the big toe joint and its function, and when you remove one of those bones, there is a chance that there could be some moderate or mild deformity that could develop in the big toe itself, either raising the big toe, or allowing the big toe to swing over in one direction or the other. In general, this risk is not strong, but it’s still possible. Unfortunately, it must be taken into consideration when operating on this particular area. However, the risk of this potential deformity is significantly less important than the need to reduce pain and reduce the ability to be able to function again by removing the sesamoid and relieving the pain from the condition.