Sesamoiditis

Have you been experiencing pain in the foot, particularly in the bone of the foot just before the big toe? Does your daily routine include jumping, dancing, or wearing flexible flats or high heels? Do you train on hard surfaces all the time? An answer of yes to any of these questions may put you at risk for developing sesamoiditis. Sesamoiditis may sound like a complicated foot disorder but it is not.

What is sesamoiditis?

A sesamoid is a unique type of bone that is not attached to other bones. Instead, it is attached to tendons or muscles. The sesamoid bones of the foot are a pair of bones located in both sides of the first foot bone (ball of the foot) adjacent to the big toe.  This pair of bones provides leverage to the muscles of the foot for better mobility of the big toe. The tendons attached to the sesamoid bones can be inflamed over time due to repetitive movement such as abrupt landings during sports and dancing. This is known as sesamoiditis. Pain over the sole aspect of the foot bone adjacent to the big toe is the most common symptom associated with seasamoiditis. Some may experience warmth and redness over the area of pain. Others can have difficulty moving the big toe.

To recap the presentation of sesamoiditis:

• Pain over the sole of the first foot bone (ball of the foot) adjacent to the big toe
• Swelling and redness over the first foot bone
• Difficulty moving the big toe

What are the risk factors for sesamoiditis?

Chronic, repetitive microtrauma can induce inflammation of the tendons surrounding the sesamoid bones.  Here are some of the risk factors.

• Type of foot wear
  1. Narrow toe boxes - Narrow-toe boxes cramp the forefoot and restrict the motion of the toes. The tendons surrounding the sesamoid bone become stiff as well. Since stiff tendons do not permit good mobility, increase in toe motion such as jumping will lead to tendon inflammation.
  2. Overly flexible shoe - Overly flexible shoes allow extreme big toe motion. The tendons have to stiffen repeatedly in order to counter excessive movement. Over time, this can lead to sesamoiditis.
  3. Elevated Heels - Elevated heels load the forefoot and place the tendons in a shortened state. Chronic shortening of the tendon makes it weak and vulnerable to stress causing sesamoiditis.

• Training in hard surface

Repetitive pounding of the forefoot against hard surface is bad for the tendons and bones. More energy is lost during contact of the foot with the floor; hence, the foot, particularly the big toe, will work harder to allow locomotion. Overuse of the tendons attached to the sesamoid bones can lead to sesamoiditis.

• Training or athletic activity

Activities that require frequent abrupt landing and movement of the big toe (i.e. dancing, basketball, volleyball) places excessive load on the big toe Chronic exposure of the big toe to repeated high-impact loads might cause inflammation of the tendons surrounding the sesamoid bones.

How to diagnose sesamoiditis?

Good history taking and physical examination by a licensed physician will often lead to a diagnosis of sesamoiditis. Additional imaging procedures such as x-ray or MRI are only necessary when there is suspicion of fracture.

Treatment

• Correcting habits to relieve big toe pressure

Unloading the forefoot, particularly the big toe, is top priority during treatment of sesamoiditis. This allows the inflamed tendons to rest and heal. Changing training techniques are necessary in active individuals. Avoiding training in hard surfaces is a good start. Wearing a shoe that has a thick rubber sole (i.e. cross trainers) for daily activities prevents excessive load to the big toe. Avoiding wearing of shoes with narrow toe boxes, elevated heels and flexible soles should also be practiced to prevent chronic stress to the toes. Jogging instead of sprinting allows a more even distribution of bodyweight to the foot.

• Rehabilitation

Rehabilitation centers on strengthening the muscles of the soles of the feet, improving balance and coordination, and improving big toe strength and flexibility. This will correct the mechanics of the foot during activity to prevent recurrence of sesamoiditis.

• Gel inserts

Commercially available gel inserts are useful in transmitting forces more equally across the sole of the foot. This affords the big toe and the surrounding tendons some rest.

• Metatarsal (Forefoot bone) pads

A metatarsal gel pad is used to remove pressure off the forefoot. The pads are placed just before the ball of the foot to alleviate stress on the front part of the foot.

• Orthoses

Custom-made foot orthoses distributes weight more evenly across the sole; however, it is an expensive treatment option and often reserved when the abovementioned treatment options fail.

Surgery and steroid injection are of no benefit for sesamoiditis.