How long have you been feeling a sharp pain under your foot, specifically in the ball near your toes?
Bones usually are connected to one another but with one exception — sesamoids. Instead, they’re attached to tendons and within muscles.
When increased pressure on these bones occurs, a pain manifests itself. And that nuisance is described as the condition: sesamoiditis.
Read on and learn the causes and symptoms, and treatments recommended by orthopaedists.
Sesamoid Bones
(Image Credit: Wikimedia Commons)
In the normal foot, you’ll find these two pea-shaped bones beneath your big toe joint. They are embedded within a tendon near joint surfaces.
Sesamoid bones act like small pulleys and have a similar appearance to tiny kneecaps. They provide a smooth surface over which the tendons slide, relieving tension. Their position takes a lot of impact from body weight while supporting the big toe.
But overuse of the tendons caused by increased pressure or loading can sneak up on you. The foot pain comes and goes, and it may start from a vague ache to an intense throbbing one.
This inflammation is the birth of sesamoiditis.
Sesamoiditis
(Sesamoiditis is a common ailment that affects the forefoot. Athletes and dancers are especially susceptible to this. It’s also usual with those who overwork their tendon attachments on the sesamoid bone.
Causes
Sesamoid bones bear the stress of shock absorption from walking, running and dancing. Sports such as tennis, and football, along with ballet and dance steps, also take a gamble.
Soreness occurs when the tendons surrounding the sesamoids become inflamed.
Footwear also plays a big role. Those who wear high-heeled shoes with high arches or flat feet are prone to this chronic injury.
In rare cases, it can be a side effect of gout, an inflammatory arthritis that affects the big toe joint. If you experience in any of these situations, you’re at a higher risk.
Symptoms
The pain is often focused beneath the big toe joint around the ball of the foot. It can be gradual with a sign of swelling or bruising. However, if a sesamoid stress fracture is present, aching will occur immediately.
Difficulty in straightening or bending the toe is also a sign of sesamoiditis. One wrong move and there’d be a “pop” sensation when walking, adding to the foot pain.
Listed below are the common symptoms of sesamoid pain, as per Orthopaedic surgeons:
- A painful condition in the ball of the foot under the big toe
- Difficulty bending and straightening of the great toe
- Walking or bearing weight feels demanding
- Possible redness, bruising or swelling
- Sudden and severe pain in one or more joints (mainly for gout)
Diagnosis
The good news is that sesamoiditis can be treated with a conservative approach. But always get your condition checked with your Doctor or GP.
To diagnose a sesamoid injury, your podiatrist will examine your foot – focusing on the big toe joint. The assessment will mostly have a hands-on approach. This is to identify the particular cause and confirm the diagnosis of sesamoid pain.
Techniques needed include imaging tests, such as an X-ray, bone scan, CT scan, and MRI. Other advanced methods, like the Passive Axial Compression test, may also be used. The latter manipulates your joint in a similar way to walking to simulate the symptoms.
Sesamoiditis accompanied by a stress fracture means there’s a small crack in the bone. A suspected acute injury, on the other hand, can result in a turf toe. It’s an injury of any soft tissue structure around the sesamoid bone formation.
The case might be a bit different if the big toe joint was previously injured. The doctor may rule out ‘hallux rigidus’. It’s a condition that causes pain and stiffness in the joint at the base of the big toe.
There are a number of forefoot pathologies that can present similarly to sesamoiditis. Thus, it’s important to get routine screenings from your doctor.
A correct diagnosis ensures the right and proper treatment is administered. Don’t self-diagnose.
Treatment
The treatment will depend on the diagnosis and degree of injury. Always consult your Doctor before undertaking treatment. Here are some of the treatments your orthopaedist may recommend:
- Rest. Sesamoiditis is a recurring injury. Your doctor may suggest taking a break from activities that cause stress. A good rest helps keep pressure off the sore until the symptom/s ease.
- Footwear. Wear comfortable, low-heeled shoes. Add foot care, such as cushioning pads, at the ball of the foot to soothe stress.
- Ice and elevation. Use ice indirectly, either in an ice pack or wrapped in a towel. This method helps reduce inflammation.
- Mobilisation. Manual therapy may be provided, addressing at-home exercises related to the injury.
- Taping or bracing. Your doctor may recommend taping your big toe in a downward-pointing direction. This helps aid pressure on the sesamoid bones. In more severe cases, you may need a removable leg brace to restrict movement – ideally, for four to six weeks.
- Physical therapy. If a brace has restricted your foot, physical therapy may be necessary aftward. The purpose is to restore the range of motion to your footing and speed healing.
- Oral medications. Your healthcare provider will help you determine if NSAIDs are right for you. Such medications may be used as a temporary measure. NSAID stands for Non-steroidal anti-inflammatory drugs.
- Steroid injections. For rare, severe cases only. Injections help reduce pain and swelling and are usually done under radiological guidance.
- Surgery. Surgical removal of one sesamoid bone may be the last resort. But this is only necessary if the symptoms don’t resolve over time. Your podiatrist can help explain the surgical options. You may also ask them for guidance on surgeon referral for this procedure.
Recovery
The recovery time depends on the severity, from mild to severe. Mild cases may resolve within days, severe ones can take months, and surgery may prolong.
Consult your doctor to give you the best treatment options and ensure a rapid recovery.
Prevention
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There are ways to lower your chances of developing sesamoiditis, and these are:
- Wearing sensible and comfortable shoes, such as sneakers. Don’t cramp your toes in a narrow toe box. Replace when the cushioning wears down.
- The use of orthotic insoles, especially if you often do heavy lifting or crouching. Plus, other activities that put pressure on the sesamoids.
The key to a healthy recovery and prevention is to keep the pressure off your sesamoids. If symptoms persist, don’t let pain stand in your way and seek treatment ASAP.
Take the health of your feet into the hands of your trusted podiatrist and follow their guidance.