Sesamoiditis

Sesamoiditis is a common condition of the forefoot. Pain is in the ball of the foot specifically under the big toe joint. The sesamoids are small bones located under the big toe joint. These bones are in the tendons that run to the big toe on the under surface. Due to their location and function they are subjected to immense pressure and forces every time the big toe is used to push the foot forward.

Symptoms

Sesamoiditis is localized. Typically it may present with a mild ache increasing gradually to an intense throbbing. People participating in activities and sports that involve repetitive, excessive loading of the ball of the foot such as dancing and sprinting often suffer from this condition. People with higher arched feet tend to have more pressure on the balls of their feet also tend to be more prone to sesamoiditis. It may be an occupational hazard and common in professions where you are on your haunches, this adds direct pressure to the sesamoids.

Treatment

Conservative

Treatment will vary according to the situation. It will involve a period of rest from any activities likely to aggravate the problem. Immobilization strapping, ice and oral anti-inflammatories may also be utilized to settle inflammation and pain. A soft full length functional orthotic is commonly used to float the sesamoids and deflect pressure away from the painful area. Orthotics are essential in treating an underlying causative foot condition, such as flat feet (pes planus), high arched feet (pes cavus), bunions or those with reduced plantar fatty padding. In the case of persistent severe sesamoiditis or stress fractures of the sesamoids, a boot  may be required for up to 6 weeks. Failing this an injection of steroids may be considered. Surgery must used as a last resort.

Surgery

In severe cases or following a true fracture of the sesamoids, surgery may be required to remove the damaged or fragmented sesamoid bone. Also in some cases, due to reduced blood supply there may be delayed or absent healing and a surgical review is warranted.

Expected Outcome

Most individuals will have immediate improvement is symptoms with conservative care, with total resolution achieved within months. It is essential to address the causative factors rather than the symptoms alone.