Sesamoiditis

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The foot is the lowermost point of the human leg. The foot’s overall shape, along with the body’s natural system of balance-keeping, make each person capable of not only walking, but also running, climbing, and countless other activities.

A sesamoid is a bone embedded in a tendon. Sesamoids are located in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones found in the ball of the foot, beneath the big toe joint. Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe pushes off during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and / or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. Additionally, people with high arches are at risk for developing sesamoid problems.

Sesamoiditis is a kind of tendonitis (inflammation of the tendons) that occurs in the ball of the foot. Because the tendons in the ball of the foot have tiny sesamoid bones embedded in them, these bones can become inflamed along with the tendons. The two pea-sized sesamoid bones sit under the big toe joint, where they provide leverage when the tendons load enough weight onto the ball of the foot. Certain activities that frequently transfer weight to the ball of the foot (including running, walking, and dancing) can overstress these tendons and bones, thus causing inflammation and pain.

Sesamoiditis can also be misdiagnosed by a similar type of sesamoid injury known as a ‘turf toe’. This is an injury of the soft tissue surrounding the big toe joint. It typically occurs when the big toe joint is extended beyond its regular range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the overall motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture off the sesamoid. Sometimes a sudden “popping” sound may be heard and felt at the moment of the injury.

Causes & Symptoms

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Sesamoid pain can develop in a number of different ways. In cases of sesamoiditis, it is often caused by doing the same types of toe movements over and over again, which happens in activities like running and dancing. Fractures can also cause pain in the sesamoids. It can occur in a sesamoid bone as acute or chronic, as described below:

  • Acute fracture – Most commonly caused by trauma (a direct blow or impact to the bone). An acute sesamoid fracture produces immediate pain and swelling at the site of the break but usually does not affect the entire big toe joint.
  • Chronic fracture – A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.

While most bones in your body are connected to other bones, sesamoid bones are quite unique in that they’re only connected to tendons. They tend to interact with the tendons as they move and are subject to the same stress from the same movements. Generally, sesamoid bones exist in the feet, hands, and knees, however, sesamoiditis refers to the foot bones. These bones bear the extra stress of shock absorption from walking. The sesamoid closer to the middle of the foot (the medial sesamoid) bears more of this stress and is much more often affected, but the tibial sesamoid may also be affected by sesamoiditis.

It is always important to note that the sesamoid bones can either become fractured or have sesamoiditis. The main difference is in the way you feel pain. Therefore, if you have sesamoiditis, here are some of the symptoms you may experience:

  • Limited movement – There may be an amount of difficulty and pain in straightening or bending your big toe.
  • Hard surfaces – Pain will increase when you attempt to walk on hard surfaces, such as steel, concrete, sand. There may also be pain directly below the big toe on the ball of the foot.
  • Swelling – Swelling can appear rapidly after developing the early stages of sesamoiditis. Swelling may be felt around your big toe.
  • Increase in pain – Pain may start to gradually increase, unlike a fracture that triggers instant pain.

Since sesamoiditis develops gradually, you may feel a dull pain at intervals during the day. This pain occurs at the base of the foot and toes. Sometimes the pain makes you limp or transfers your weight to the other foot to relieve pain in the affected foot.

Who gets Sesamoiditis?

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Certain risk factors associated with sesamoiditis include the following:

  • Sports – Sesamoiditis is more likely to occur after fracturing your sesamoid bone. Some of these sports activities include ballet, dancers, basketball, soccer, and football.
  • Lack of nutrients – Eating disorders and lack of nutrients (vitamin D or calcium) can make bones more likely to develop sesamoiditis.
  • Osteoporosis – Conditions that are linked to the degeneration of bone can weaken your bones and make it easier for sesamoid injuries to occur.
  • Increase in activity intensity – Sesamoid fractures commonly occur in people who shift from a sedentary lifestyle to an active training regimen or who rapidly increase the intensity, duration, or frequency of training sessions.

How does it affect you? How serious is it?

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Similar to other fractures, when sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited for your recovery. In all cases of surgical treatment, each normally requires incisions. Therefore, this means there is a chance of complications but with a low percentage of it happening. Here are some complications of foot surgery:

  • Foot pain – Some patients tend to continue to have persistent sesamoid bone pain after surgery.
  • Big toe stiffness – Long-term stiffness is typically caused by excessive scar tissue.
  • Nerve or blood vessel damage – During surgery, there’s a minimal chance that the nerves, veins, or tissue around your feet can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the affected foot.

Recommended Treatment & Rehabilitation

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During a diagnosis for sesamoiditis, a physician will look for tenderness at the sesamoid bones. Your doctor may also manipulate the bone slightly or ask you to bend and straighten the toe. He or she may also bend the big toe up toward the top of the foot to see if the pain intensifies.

Afterward, your physician will request X-rays of the forefoot to ensure a proper diagnosis. In many patients, the sesamoid bone closer to the center of the foot (medial sesamoid) has two parts. Because the edges of a bipartite medial sesamoid are generally smooth, and the edges of a fractured sesamoid are jagged, leading to an X-ray becoming successful in making an accurate diagnosis.

Your physician may also request X-rays of the other foot to compare the bone structure. If the X-rays appear normal, your physician may request a bone scan. A bone scan is a specialized radiology procedure used to examine the various bones of the skeleton. It is done to identify areas of physical and chemical changes in bone.

Most sesamoid injuries do not require surgery. They can be well-managed by working with a physiotherapist.  

Your treatment plan will depend on the severity of your injury and your goals. Therefore, the following are typical treatment options, depending on the grade of your condition:

  • Grade 1 – Taping and / or inserts may be used to help restrict painful motion at first. In many cases, an athlete may return to sports within a few weeks. Often, your physiotherapist will have you perform strength and weight-bearing exercises almost immediately.
  • Grade 2 – A brace or walking boot may be prescribed for several weeks to restrict movement and allow rest. Your physiotherapist will then start you on a structured exercise program and a safe return to your regular activities.

With any degree of injury, your physiotherapist will work with you to design a specific treatment plan for your grand recovery. Your treatment programs may include:

Range-of-motion exercises

It is very important to regain the full range of motion of your big toe and foot. If your injury required the use of a brace or boot to restrict movement during healing, your toe and foot joints may be stiff. Therefore, your therapist will teach you gentle stretching and movement exercises, including guided toe exercises, to help restore normal movement.

 

Muscle-strengthening

It is common to lose strength in the muscles of your foot, ankle, and leg after sesamoiditis. This is due to the change in activity and any bracing or boot used to restrict movement during healing. Your physiotherapist will determine which muscles are weak and teach you a combination of exercises to strengthen them.

Manual therapy

Manual therapy can be especially effective to restore movement in joints that become stiff after being immobilized. Your therapist may gently move the joints involving your injury for you.

Medical education

Your physiotherapist will educate you to help ensure that your recovery is completely healed. He or she will identify any activities you should avoid or limit at certain stages in your recovery.

 

Exercises may be suggested for a condition or for rehabilitation. Start each exercise slowly while easing off the exercises if you start to have pain. Here are some exercises for you to try:

 

Calf wall stretch

Stand facing a wall with your hands on the wall at about eye level. Put your affected foot about a step behind your other foot. Keeping your back leg straight and your back heel on the floor, bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg. Finally, hold this stretch for at least 15-30 seconds, then repeat 2-4 more times.

 

Marble pick-ups

Put some marbles on the floor next to a cup. Sit in a chair, and use the toes of your affected foot to lift up one marble from the floor at a time. Then try to put the marble in the cup. It is often recommended to repeat this procedure 8-12 times.

 

Towel scrunches

Sit in a chair and place both feet on a towel on the floor. Scrunch the towel toward you with your tows. Then use your toes to push the towel back into place before repeating 8-12 times.

 

Towel inversion and eversion

Sit in a chair, and place both feet on a towel on the floor. Swivel your feet from side to side to slide the towel. First slide your toes, then your heels, as you move the towel with your feet. Then change directions and swivel your feet from side to side to slide the towel back to the starting position.

Alternative & Homeopathic Treatment

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To help ease your sesamoid pain, it is recommended to try these at-home treatments, such as:

 

Rest

Protect your big toe from further injury by not stressing it. Elevate your foot after standing or walking. You might need to avoid your favorite sport for a while, but you can stay fit with low-impact exercises, such as swimming or cycling.

 

Ice application

Applying ice to your foot can be very helpful as a pain reliever. Ice should be applied as soon as possible after injury for 10-30 minutes. Make an ice pack by wrapping ice cubes in a plastic bag or towel, or by using a bag of frozen peas. Gently press the ice pack onto the injured part. The cold is thought to reduce blood flow to the damaged area. This may limit pain, inflammation, and bruising.

 

Wear proper shoes

Avoid too-tight or too-loose shoes and limit your wearing of high heels. Wear shoes appropriate to the sports you play.