Last reviewed by Dr. Raj MD on January 12th, 2022.
What is Sesamoiditis?
Sesamoiditis is a common condition of the forefoot and is characterized by pain at the bottom of the big toe. Sesamoiditis is an inflammatory condition that involves the sesamoid bone particularly at the 1st metatarsophalangeal joint. This inflammatory condition is a common occurrence among young adults who are physically active and those engaged in sports.
Sesamoid bones are bones that are not connected with any other bone but are instead entrenched in the muscles or are wrapped in the tendon. The sesamoid bones are small and rounded mass located at the base of the foot exactly at the rear of the large toe. It primarily acts as a pulley and alters the direction in muscle pull. The sesamoid bones also allow the tendons to slide to boost the ability of the bone in modifying pressure and to lessen friction. Sesamoid bones can also be found on the upper extremities but can only be found in the hand particularly at the palmar surface. It is however seldom found in the upper limb. The lower extremity also consists of the sesamoid bone and can be located exactly at the patella which is regarded to be the largest sesamoid bone in the human body. The sesamoid bone on the foot also functions in absorbing great impact forces during walking, running and jumping. Bending of the big toe is also possible to the sesamoid bone which acts as a fulcrum that provides the flexor tendons with the mechanical advantages to be able to allow pull of the big toe down when walking.
The inflammation of the sesamoid bones is a condition known as Sesamoiditis and which can cause significant pain. The pain in Sesamoiditis can be unvarying or it can be aggravated with every movement of the big toe. Sesamoiditis is a non-life threatening condition but it can affect the quality of life or may affect the daily activities especially those engaged in sports.
Sesamoiditis is marked by a pain at the base of the foot just behind the forefoot. The onset of pain can be gradual or it can be rapid depending on the cause of the inflammation and is localized at the base of the great toe. The pain is usually perceived when bearing weight or particularly perceived in the weight bearing area. The pain in sesamoiditis is usually constant although it may also be perceived when aggravated or when there is movement of the affected big toe.
Bending and extending of the big toe is also difficult which can be associated with the inflammation including the pain that can make movement uncomfortable. Bending and extending of the great toe can also be so painful and difficult to achieve. A limping gait is usual in an effort to avoid the pain when weight and pressure is applied on the affected area. Limping may also be due to the effort of shifting weight outside the affected area during walking.
The symptoms of swelling and bruising may also occur although not all affected individuals exhibit these symptoms. The swelling and tenderness is usually observed at the base or the under surface of the ball joint.
Sesamoiditis is the consequence or usually occur as a result of chronic pressure or tension applied to the structures of the first metatarsophalangeal joint. This is especially true when the forefoot is subjected to repetitive movement and excessive pressure is applied. Athletes or those engaged in sports and physically active individuals are those commonly affected with Sesamoiditis.
The inflammation of the tissue surrounding the sesamoid bone is the usual response when trauma or injury and any form of irritation are present and subjected towards the sesamoid bone.
Sudden increase in activity and activities requiring repetitive impact against the ball joint are also among the common cause of Sesamoiditis. Track runner, ballet dancers and baseball players are commonly affected with Sesamoiditis as a result of repetitive impact and increase in activity.
A sesamoid fracture is a fracture of either one or both of the sesamoid bones which are substantial enough to cause inflammation of the sesamoid bones. The fracture of sesamoid bone or bones is usually the result of traumatic injury such as falling from heights subsequently landing on the feet.
A stress fracture is also a common cause of Sesamoiditis. The microscopic tears in the bone are the result of repetitive use of the sesamoid bone or the ball joint of the foot. Individuals engaged in basketball, dancing, badminton, tennis and other sports that require sudden change of direction are more prone to developing a stress fracture which can cause an inflammation of the tissues surrounding the sesamoid bone.
Overpronation is another factor considered to cause Sesamoiditis. The over pronation of the sesamoid may cause displacement in sideways manner of the sesamoid bones which later can cause wear and tear of the first metatarsophalangeal joint.
Individuals with bony feet are at high risk for developing Sesamoiditis. Individuals with bony feet have no sufficient fat to absorb high impact force in order to protect the sesamoid. Individuals with high arches in their feet are also at risk for Sesamoiditis as pressure in weight bearing is usually placed on the ball of the foot.
Sesamoiditis is a non-serious and non-life threatening inflammatory condition. The treatment is usually non-invasive and the goal is to reduce the inflammation and alleviate the pain and to restore the normal function of the sesamoid bones.
Rest is the usual treatment for mild to moderate inflammation. Cessation of use of the affected foot is generally required until the inflammation has resolved. Ice application over the affected area is also another treatment considered for Sesamoiditis.
A modified shoe and the use of metatarsal pad are beneficial in redistributing the pressure on the ball joint thereby reducing the pressure towards the affected area. The pain on the other hand can be alleviated with over-the-counter pain reliever drugs.
Surgical treatment is usually the last resort in treating Sesamoiditis. This is especially indicated to Sesamoiditis that remains unresponsive to non-invasive treatment, particularly if sesamoid fracture or stress fracture is present. A surgical procedure to remove the sesamoid bone is usually done with caution as the procedure may result to deformities of the big toes which can result in further complications.