Most bones in the human body are connected to each other by joints. However, some bones are connected only to tendons or are embedded in muscles. These are called sesamoids. Two small sesamoids found underneath the big toe joint act like pulleys providing a smooth surface over which the tendons slide. They also assist with weightbearing and help elevate the bones of the big toe. Like other bones, sesamoids can break (fracture) with impact. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. When the surrounding tendons become inflamed, we call this sesamoiditis. It is ultimately a form of tendinitis. Sesamoiditis is common among ballet dancers, runners and baseball catchers.
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Symptoms
Sesamoiditis is typically a slower onset of pain, discomfort and mild swelling. Swelling and bruising may or may not occur. A fast onset “acute” pain would be more likely to be due to a sesamoid fracture. Movement associated with bearing weight on the big toe joint, kneeling, wearing high heeled shoes can cause significant pain. It is typically localized to just underneath the big toe joint (metatarsal head). If the pain is sharp, sudden or radiates, this is not likely sesamoiditis.
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Causes
Sesamoid injuries—which can involve the bones, tendons, and/or surrounding tissue in the joint—are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequently wearing high-heeled shoes can also be a contributing factor. The diagnosis is typically through examination, but an x-ray is helpful to ensure there is no sesamoid fracture.
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Treatment
Anti-inflammatory medications, such as Ibuprofen, can be helpful for immediate pain relief. However, RICE (rest, ice, compression, elevation) is important as it offers localized improvements in pain, swelling and encourages healing. Reducing activities, padding shoes, and taking the pressure off the area is imperative. An orthotic that is customized to offload the sesamoid bones is a great strategy and will be helpful to prevent recurrence after healing is complete. A shoe that fits properly, has a 1.5 inch or lower heel, and is cushioned is a great option. However, a Canadian Certified Pedorthist can assist with shoe fittings or footwear modifications when needed, such as a rocker bottom sole. Foot pain is not normal. If you are having discomfort, visit us for an assessment.