Sesamoiditis

Sesamoids are two very small bone structure (each about the size of a pea) found on the underside of the front part of the foot (forefoot) near the big toe.

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

One of the common problems with sesamoids is sesamoiditis whereby 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.

Typically, an x-ray is able to show and confirm the diagnosis in cases of bone fracture. However, sesamoid fractures can be hard to diagnose with x-rays due to their small size. A bone scan may be suggested for an accurate diagnosis and to determine the severity of the condition.

Common Symptoms

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

The usual home remedies for temporary pain relief associated with sesamoiditis include rest, ice compression and cushioning the sole of the big toe. Medications to relieve pain may also ease the pain temporarily.

Treatment Options

If left untreated, surgery may be necessary. To avoid this outcome, consult a foot pain specialist, such as a podiatrist, who will utilise non-invasive conservative management to relieve pain and prevent the condition from deteriorating. These treatments can range from extracorporeal shockwave therapy and pulsed electromagnetic field therapy to customised foot orthotics for shaping and correction. If your condition is sufficiently severe, the podiatrist may refer you to an orthopaedic surgeon for surgical removal of the sesamoid bone.

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 your personalised treatment plan to avoid complications such as foot disability and reduced quality of life.

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