East Coast Podiatry
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Last Updated: 06 Sep 2021

Sesamoiditis

What are sesamoid bones?

Sesamoid bones are embedded in the tendons found across the body. The most well-known sesamoid bones of the foot are two pea-sized bone structures found on the front part of the foot below the big toe.

The sesamoids act like pulleys, providing a smooth surface and canal for the tendons in the big toe to slide and transmit muscular forces. It assists with weight bearing and helps elevate the bones of the big toe. On top of that, the sesamoids serve as a fulcrum during walking, especially during the toe-off phase of the gait cycle.

How can my sesamoids be injured?

Sesamoiditis is one of the most common sesamoid-related problems; it occurs when the sesamoids become inflamed, affecting the surrounding tissues. This inflammation may cause intense pain below the first metatarsal joint in the ball of the foot.

Recurrent stress on the sesamoids often results in injury to the bone, tendon and surrounding joint tissues. One such injury that can be sustained is turf toe, which is a sprain to the big toe joint due to excessive upward bending. Impact that is repetitive or forceful enough may also result in a fracture, osteoarthritis or osteonecrosis of the sesamoid.

What happens if you break a sesamoid bone?

Typically, x-rays are used to detect and confirm the diagnosis in cases of bone fracture. However, due to their small size and multiple differential diagnoses, diagnostic ultrasound imaging may be supplemented for a more accurate diagnosis and to further determine the severity of the condition.

X-ray of healthy sesamoids
X-ray of bipartite sesamoids or fracture

Common Symptoms

  • Pain underneath the big toe in the ball of the feet
  • Aching and pain when walking or standing
  • Pain worsens during toe-off or when the toe is bent when walking
  • Difficulty in bending the big toe
  • Pain may develop gradually for overuse injuries, but acute pain will be immediate when the fracture occurs

The usual home remedies to relieve pain associated with sesamoiditis, include rest, ice compression and cushioning the sole of the big toe. Medications may also be taken for temporary pain relief. However, if symptoms do not subside after 3 days of home treatment, you should consult a healthcare professional for proper assessment and treatment.

Treatment Options

If neglected, the condition may continue to develop till surgery is unavoidable. To avoid this outcome, consult a foot pain specialist, such as a podiatrist, for non-invasive conservative management to relieve pain and prevent condition progression. After assessing the nature of your injury, the treatment may be focused on targeting and healing a bone fracture, reducing soft tissue swelling and nerve pain, or increasing the range of motion around a scarred joint.

At East Coast Podiatry, our podiatrists will perform a thorough biomechanical and musculoskeletal assessment of the lower limb to generate a diagnosis. Once the diagnosis is confirmed, your podiatrist will discuss and start your personalised treatment plan that is aimed to avoid complications, such as foot disability, helping to maintain a good quality of life and improving functional mobility.

Our treatments can range from extracorporeal shockwave therapy and pulsed electromagnetic field therapy to customised foot orthotics for shaping, offloading and correction. If your condition is too severe, the podiatrist may refer you to an orthopaedic surgeon for surgical removal of the sesamoid bones.

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