Sesamoiditis is a common ailment that affects the forefoot, typically in young people who engage in physical activity like running or dancing. Its most common symptom is pain in the ball-of-the-foot, especially on the medial or inner side. The term is a general description for any irritation of the sesamoid bones, which are tiny bones within the tendons that run to the big toe. Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, sesamoiditis is really a kind of tendinitis – the tendons around the bones become inflamed as well.
There are a number of causes of sesamoiditis, although the age of patients can indicate which is most likely. In the older age ranges the condition is most commonly due to arthritic changes to the sesamoid bones, usually at the point where they articulate with the head of the first metatarsal.
Osteoarthritis of the sesamoid bones is the most likely cause in older patients, and may involve the formation of additional bone in the form of a bone spur. This bone fragment can cause inflammation of the surrounding muscles and tendons as well as the sesamoid bones themselves becoming inflamed. Osteoporosis is another factor, which weakens the bones, reducing their ability to cope with the forces from walking. Whilst this is common with older patients, it can also be a cause of sesamoiditis in younger women, especially those with a history of eating disorders or irregular menstruation.
Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. It may build to an intense throbbing. In most cases there is little or no bruising or redness. One of the major causes of sesamoiditis is increased activity. You’ve probably stepped up your activity level lately, which has forced you to put more pressure on the balls of your feet. Speedwork, hillwork, or even increased mileage can cause this. If you have a bony foot, you simply may not have enough fat on your foot to protect your tender sesamoids. Also, if you have a high arched foot, you will naturally run on the balls-of-your-feet, adding even more pressure.
Treatment and Prevention
Treatment for sesamoiditis is usually noninvasive. Minor cases require a strict period of rest and the use of a modified shoe or a shoe pad with a cutout to reduce pressure on the affected area. A metatarsal pad can be placed away from the joint to redistribute the pressure of weight bearing to other parts of the forefoot.
Treatment for sesamoiditis is almost always noninvasive. Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot. In addition, the big toe may be bound with tape or athletic strapping to immobilize the joint as much as possible and allow for healing to occur. It is recommended to decrease or stop activity for awhile. This will give your sesamoids time to heal. You should apply ice to the area for 10 to 15 minutes after exercise, or after any activity that aggravates the area. As with icing, anti-inflammatories will help the swelling go down so healing can begin. While the injury is healing, women should wear flat shoes on a daily basis.