Sesmoiditis - Causes, Symptoms, and Treatment

What Does Sesmoiditis Mean?

Sesamoiditis refers to the swelling of the sesamoid bones which are present in the ball of the foot and the tendons. A sesamoid bone is present deep in a tendon. They are located in several joints in the body. In the normal foot, the sesamoids are present as paired pea-shaped bones found in the ball of the foot underneath the big toe joint.

Serving as a pulley for tendons, the sesamoids support the big toe to move normally and provide leverage when tendons load weight onto the ball of the foot. Various activities often transfer weight to the ball of the foot, such as running, dancing, and walking in high heels. Unfortunately, these activities can overstress the tendons and these bones, causing inflammation and pain.

What Causes Sesamoiditis?

Sesamoiditis typically develops gradually due to overuse and repetitive impact on the tendons in the foot. It primarily affects runners, dancers, and athletes who get it from over-practicing movements that transfer repetitive stress to the ball of the foot. In addition, people who wear high heels, have very flat feet or have very high arches, or walk with an inward roll can get it just from walking. Rarely, sesamoiditis can also be a side effect of gout (a type of arthritis that occurs when too much uric acid in the body forms crystals in the joints).

Who Is at Risk for Sesamoiditis?

Anyone can get sesamoiditis, but individuals whose regular activities cause more repetitive stress or weight to the tendons and sesamoid bones in the feet are more predisposed to get it.

These include:

• Runners.

• Dancers.

• Athletes.

• People with flat feet.

• People who frequently wear high heels.

• People with high arches.

• People whose feet roll inwards as they walk (overpronation).

• People affected with gout.

The most commonly affected joint is the big toe, but can also involve joints such as the ankle, elbow, wrist, and knee.

What Are the Symptoms of Sesamoiditis?

Sesamoiditis develops gradually. The most obvious and common symptom of sesamoiditis is a pain in the ball of the foot: particularly under the joint of the big toe. There may be a dull ache under the big toe that builds until it becomes painful to walk. Conversely, the pain will be immediate if a bone fracture (stress fracture) accompanies the sesamoiditis.

Other symptoms can include:

• Bruising.

• Swelling.

• Redness.

• Pain under the big toe.

• Difficulty in bending the first toe.

• Difficulty in bearing weight on the ball of the foot.

• Difficulty while walking.

How Is Sesamoiditis Diagnosed?

The healthcare provider asks about how the pain started and then begins by physically examining the affected foot. The provider gently checks for tenderness in the ball of the foot and moves the big toe in various directions to test the mobility. They may use a technique known as the passive axial compression test that manipulates the joint similarly to walking to reproduce the sesamoiditis symptoms. In addition, they may also order imaging tests to confirm or distinguish certain related disorders.

Sometimes sesamoiditis may be accompanied by a stress fracture, a small crack in the bone due to repetitive stress. If the healthcare provider suspects an acute injury, they may screen for an acute bone fracture or turf toe (sprain of the big toe's main joint). If someone has previously injured the big toe joint, the provider may rule out hallux rigidus (degenerative arthritis characterized by pain and stiffness in the metatarsophalangeal joint). Imaging tests often ordered include X-ray, bone scan, computer tomography scan, ultrasound, and magnetic resonance imaging .

How Is Sesamoiditis Treated?

Treatment for sesamoiditis is usually non-operative, and most treatment plans focus on lifestyle modifications and pain relief.

Treatment includes one or more of the following options, based on the severity of the injury:

• Rest: Because sesamoiditis is a repetitive stress injury, the first thing is to stop the activities causing the stress on the ball of the foot. One should keep pressure off of the injury until symptoms improve. If high heels or other shoes put pressure on the sesamoids, avoid them and choose more supportive and comfortable footwear. Wear soft-soled and low-heeled shoes. Stiff-soled shoes such as clogs may also be comfortable.

• Elevation and Ice Pack: Rest and ice the sole of the feet. Use ice either with an ice pack or with a towel. It should not be applied directly on the skin; either use an ice pack or wrap the ice in a thin cloth or a towel.

• Restriction: The healthcare provider may suggest temporarily strapping or taping the big toe to relieve that area of tension. They may suggest a short leg fracture brace for more severe cases to limit movement. If symptoms persist, one may need to wear a removable short-leg fracture brace for over four to six weeks.

• Physical Therapy: If a brace or bandaging has restricted the foot, your healthcare provider may recommend physical therapy such as exercises (range of motion, strengthening, and conditioning) afterward to restore range of motion.

• Soft Tissue Therapy: The healthcare provider may use therapeutic ultrasound, soft tissue massage, or moist heat to help rehabilitate the tissues.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications help reduce inflammation and pain management.

• Steroid Injection: In rare, severe cases, cortisone is injected directly into the injured tissue to reduce pain and inflammation.

• Orthotic Devices: Custom-made orthotic devices that fit into the shoe may be recommended for long-term treatment of sesamoiditis to balance the stress placed on the ball of the foot.

• Surgery: Rarely, in chronic sesamoiditis cases, surgery might be the last option when symptoms do not resolve over time or if other strategies are unsuccessful. It is best to remove one but not both of the sesamoid bones. This can help bring relief. However, if both sesamoids are taken out, it can damage the big toe. It will no longer line up healthily.

What Is the Outlook After Treatment for Sesamoiditis?

Sesamoiditis can range from mild to severe; recovery depends on severity. Mild cases often resolve within a few days with lifestyle modifications and pain relief. However, severe cases may take several months to heal. Surgery prolongs recovery time. Keep the pressure off the sesamoids by stopping the activities causing repetitive stress to the joint.

Unfortunately, sesamoiditis cannot be cured entirely, as it can always occur again. In addition, it can cause permanent damage if it is not allowed to heal fully. Therefore, it is important to start treatment early to avoid chronic sesamoiditis and permanent damage and return to a normal lifestyle as soon as possible. Stay aware and take the pain seriously and practice preventative care.

How Can Sesamoiditis Be Prevented?

The following steps can lower the risk of developing sesamoiditis.

These include:

• Wear comfortable shoes such as sneakers. Avoid cramping the toes in a narrow toe box or straining the ball of the foot with overly high heels.

• Wear orthotic insoles, especially if someone has a job that involves a lot of weight-bearing on the feet or has anatomical factors that can lead to sesamoiditis, like high arches or flat feet.

• Preventative therapy. If there has been stress on the feet, follow strenuous activities with rest, ice, and elevation to reduce inflammation.

Conclusion

The swelling of the sesamoid bones within the ball of the foot and the tendons involved with these bones can lead to a condition called sesamoiditis. It is usually caused by overuse and repetitive stress, especially in dancers, runners, and athletes, who often bear weight on the balls of their feet. It might start as a faint pain but then erupt into intense throbbing pain.

Treatment is often nonsurgical and involves alleviating stress away from the sesamoid bones using strapping, orthotic devices, ice packs, elevation, NSAIDs, and temporarily stopping the activity causing the pain. Surgery is required when injuries fail to respond to nonsurgical treatment. Taking the health of the feet is essential by practicing preventative care.