Sesamoid bones are found at certain joints of the human body. Most well-known is the patella or knee cap. The bones assist the tendons crossing a joint to create a mechanical advantage for movement. In the foot there are two such bones that are located under the big toe.
Injury to the sesamoid bones is common due to the weight-bearing role these bones play when walking, running, and jumping.
The most common condition affecting the sesamoid bones is inflammation. This is termed sesamoiditis. Foot mechanics and shoe selection can lead to increased stress on the sesamoid bones. Other conditions that can present with similar symptoms can be sesamoid fracture or plantar plate injury.
Individuals who have sesamoiditis will feel pain in the ball of their foot just under the big toe. Sometimes this pain may be sharp and persistent, while other times it will be a dull, nagging pain. It is almost always exaggerated with activity such as running or improper shoe wear. Lifted heals place additional stress on the sesamoid bones.
How to Diagnose Sesamoiditis
Our physicians will perform a complete history and physical examination including x-rays. X-ray will help to rule out a fracture of the sesamoid bones. It is important to note that some individuals have a split (bipartite) sesamoid which is a normal variant. This appears as a line on the x-ray where the two portions of the bone have not completely grown together. If x-ray and physical exam do not provide enough detail a MRI, CT, or bone scan may be ordered.
Treatment for Sesamoiditis
Non-Surgical Treatment for Sesamoiditis
Non-surgical, conservative treatment is usually successful in easing the symptoms associated with sesamoiditis. Pain relievers and eliminating the activities that cause the pain are usually the first course of action. Icing the inflamed area and wearing loose, flat shoes with cushioned insole. Finally, something known as a Dancers pad from Hapad (Link to Hapad website dancers pad) can be used to unload the area that is aggravated from extra pressure. In extreme cases a boot or cast immobilization will be considered.
Surgical Intervention for Sesamoiditis
Surgical intervention is not typically indicated for sesamoiditis. In rare cases where a bipartite sesamoid becomes inflamed and painful, and does not heal with offloading as described above, a portion of the bone can be removed.
Post-Operative Care for Sesamoiditis
In cases where surgical intervention in needed, the patient typically remains non-weight bearing for a few weeks after surgery to allow the tissues to heal. Once sutures are removed and the soft tissue has healed patient typically begin slowly placing weight on the foot. A 6-8 week course of physical therapy is often recommended.