Sesamoiditis

Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. These are the sesamoids. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the great toe, one on the outer side of the foot and the other closer to the middle of the foot.

Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the great toe. Like other bones, sesamoids can break (fracture). Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis. It is common among ballet dancers, runners and baseball catchers.

Symptoms

Symptoms

  • Pain is focused under the great toe on the ball of the foot. With sesamoiditis, pain may develop gradually; with a fracture, pain will be immediate.

  • Swelling and bruising may or may not be present.

  • You may experience difficulty and pain in bending and straightening the great toe.

Treatment Options

Treatment is generally nonoperative. However, if conservative measures fail, your physician may recommend surgery to remove the sesamoid bone.

  • Stop the activity causing the pain.

  • Take aspirin or ibuprofen to relieve the pain.

  • Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.

  • Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.

  • Use a felt cushioning pad to relieve stress.

  • Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet.

  • Tape the great toe so that it remains bent slightly downward (plantar flexion).

  • Your doctor may recommend an injection of a steroid medication to reduce swelling.

  • If symptoms persist, you may need to wear a removable short leg fracture brace for 4 to 6 weeks.

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