What is Sesamoiditis?

Sesamoiditis is an ongoing inflammation around the sesamoid bones in the foot, specifically at the bottom area of the 1st toe.

Sesamoid bones are little bones that are found within tendons. They are most found where your tendon crosses the level of the joint. This is because these sesamoid bones help to reinforce the tendon, protects it, and allows the tendon to function efficiently.

In the foot, there are 2 pea sized sesamoid bones below the big toe that sit within a tendon in your foot that runs to the big toe. These play an important function in your walking to act as a fulcrum and increase efficiency during your walking or running activities during toe-off. Therefore, these bones not only stabilise the 1st toe joint, but also increase your foot function.

Because they are such a pivotal structure in the foot, they are subject to recurrent stress from absorbing shock from walking. Sesamoiditis can also be precipitated by any pathology that damages the bones, such as fractures, osteoarthritis or cartilage conditions.

This condition often presents itself with individuals whose activity involves repeated transferring of weight to the ball of the foot. This includes, but are not limited to:

  • Runners
  • Dancers
  • Athletes
  • Frequent use of high heels

Over training or practice is a common factor that precipitates this condition.
Individuals with certain foot postures – such as high arches, or even very flat feet can also be predisposed to having this condition.

What will I experience?

Typically, individuals who experience sesamoiditis may present with the following signs and symptoms:

  • Pain and swelling the area of the bottom aspect of the big toe joint
  • Insidious increase in pain
  • Painful on movement of the big toe
  • Difficulty and limitations with movement of the big toe
  • Pain when walking and during the toe off phase of gait

For minor cases, you may self-treat with a regiment of resting, icing the area, minimal weight-bearing and ceasing all aggravating activities. Pain killers may also be taken for pain relief. However, should these home remedies fail, it would be recommended to schedule a consultation with a Podiatrist.

How can we help you?

The first step that we must establish is the diagnosis. Your Podiatrist will run through a series of in-depth biomechanical and musculoskeletal assessments to ascertain the cause of your big toe pain. If sesamoiditis is diagnosed, your Podiatrist will discuss a management plan with you to relieve the pain, and then to identify any risk factor to prevent it from happening again and improve your functional mobility.

Treatments to splint or restrict movement may be performed to reduce aggravating the injury. If the underlying cause of the injury is mechanical in nature, your Podiatrist will be able to prescribe you a pair of orthotics specific to your foot type and function to control or minimise the risk factors, preventing recurrence in the future.

Most cases of sesamoiditis will begin to improve once the area is offloaded appropriately using devices like orthotics, or if the aggravating activity causing stress to the joint is ceased. However, returning to your normal activity requires patience and constant modification of activity to your tolerance. Your Podiatrist will work with you to ensure that your recovery is on track.

However, it is very important to note that if the injury is not allowed to rest or heal, or if underlying factors are not addressed, sesamoiditis can recur or even persist. If your condition is too severe and does not respond to conservative treatment methods, your Podiatrist may refer you to an orthopaedic surgeon for further treatment.

FAQ

Am I experiencing sesamoiditis or gout?
Sesamoiditis is mainly caused by overuse, while gout occurs due to increased build up of uric acid. In most cases, gout flare ups are sudden in nature, while pain from sesamoiditis probably built up over time. If you are concerned about your diagnosis, your Podiatrist will be able to help you properly determine the condition you are experiencing.
Is sesamoiditis the same as turf toe?
Even though these 2 conditions affect the big toe, they differ in their nature. A turf toe injury happens when the big toe is extended upwards forcefully and quickly beyond its normal range, causing sudden onset of pain and swelling. In contrast, sesamoiditis is mainly a condition resulting from overuse and develops gradually.
It is only a minor pain to my toe. Surely, I can go ahead with my activities and take a break after?
Pain from sesamoiditis can creep up on you, starting as a dull and vague ache, erupting into an intense throbbing pain. For repetitive injuries, we tend to ignore our body’s warning signs, until pain rudely stops us in our tracks. By then, rehabilitation and recovery periods may be extended. Practice good preventative care. stay aware and take the pain seriously in order to prevent permanent injury or damage to the big toe. See a Podiatrist early if you are concerned. Getting off your feet sooner, ironically will help you get back on it sooner.
Is it possible to fracture my sesamoid bones?

Yes! They are bones and have the potential to fracture under stress. X-rays are usually required to diagnose a fractured sesamoid. However, one differentiating factor could be that individuals with fractured sesamoids may have suffered a traumatic injury – such as a heavy landing on the ball of the foot. You may also find that the pain corresponded with the time of injury.

If you are concerned, do schedule a consultation with our Podiatrist. We can perform an assessment for you and if required, refer you to an orthopaedic surgeon if surgical management is required.