Sesamoiditis

X-ray of the foot A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.

Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. It's commonly associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. But in addition, sesamoiditis can occur in women who wear high-heeled shoes, hikers who wear heeled boots, in people who walk barefoot or wear thin-soled shoes, or in those who have a high-arched foot.

Symptoms

  • Pain under the big toe or on the ball of the foot.
  • Swelling and bruising.
  • Difficulty and pain in bending and straightening the big toe.

Surgery is usually not required to treat sesamoiditis.

Diagnosis

In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.

Treatments

Non-surgical

  • Discontinue the activity causing the pain and inflammation.
  • Ice the sole of the foot.
  • Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
  • Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. Note: Please consult your physician before taking any medications.
  • Injection of a steroidal medication to reduce swelling.
  • Wear shoes with cushioning that are soft-soled and low-heeled to relieve stress.

If symptoms persist, you may need to wear a removable brace on the leg for 4-6 weeks to give the inflammation time to subside and the bones to heal.

Surgical

When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

Other Sesamoid Injuries of the Foot

Turf toe 

This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the moment of injury. 

Sesamoid Fracture

A fracture (break) in a sesamoid bone can be either acute or chronic.

An acute fracture is caused by trauma – a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint.

A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.

Call us today at 206-368-7000 for an appointment, often same day. You can also request an appointment online.