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Sesamoiditis

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Sesamoiditis is the most common cause of pain beneath the big toe that our podiatrists see in runners and those that are physically active, across our Brisbane City and Newmarket clinics.

What Is Sesamoiditis?

Sesamoiditis is an overload injury that causes pain, swelling and discomfort at and beneath the big toe joint. The term ‘sesamoiditis’ comes from the name of bones affected in this injury - the sesamoid bones, paired with ‘itis’ which means inflammation. Hence, the term literally translates to inflamed sesamoid bones. 

Your sesamoids are two small pea-shaped and sized bones that sit right below your big toe joint at the ball of the foot. They are not directly connected to the big toe joint in the same way all of the other bones are connected via regular joint, but instead they are embedded within a tendon that runs directly beneath your big toe called the flexor hallucis brevis. Here, they support the function of the tendon as you walk and run. Thus, moving this tendon while you have sesamoiditis will produce painful symptoms.

Symptoms Of Sesamoiditis

Sesamoiditis is one of the leading causes of pain beneath the big toe joint at the ball of the foot during physical activity. You may also notice some swelling or redness around the joint, and bending your toe upwards will likely feel tender. Often, sesamoid pain starts as a mild ache and gradually worsens, although it can come on suddenly too, especially if you haven’t noticed the discomfort building up. You’ll typically feel better when resting, and physical activity or loading the ball of your foot will exacerbate your pain.

What Causes Sesamoiditis?

Being an overuse injury, the big toe joint at the ball of the foot, and hence the sesamoids, are repetitively loaded past the point that it can handle until damage occurs. While we often see sesamoiditis in dancers and runners due to the significant time spent on the forefoot in these sports, the overloading can come from a range of factors, including:

• Biomechanical factors - like your foot structure or function or the effects of tight or imbalanced muscles. We often see sesamoiditis in those with a high arched foot type, where a more prominent forefoot leads to increased pressure over the joints. Sesamoiditis can also often be seen in a flatter foot posture where the foot biomechanics are unsupported, so the big toe is excessively loaded with every step.
  
• Footwear - wearing high-heeled or narrow shoes that place excess pressure on the forefoot can overload the sesamoids and lead to inflammation. Wearing flat or hard soled shoes, or continuing to wear shoes after they’ve worn down can also contribute to the development of sesamoiditis.
  
• Trauma - sesamoiditis can also occur from a one-off event like jumping down from a high surface and applying direct force onto the sesamoids at the ball of the foot. This can even cause a sesamoid fracture.
  
• Weight-bearing exercise - as we mentioned earlier, exercises that load the forefoot like running, dancing, and even basketball from all the jumps can increase your likelihood of developing sesamoiditis.
  

Risk Factors

The people we see in our clinic with sesamoiditis often tend to be those that are active in sports, as well as those that wear high heels throughout the day at work. Occasionally we also see sesamoiditis in those with arthritis that affects their forefoot, namely rheumatoid arthritis or gout.

Diagnosis

Sesamoiditis can be confidently diagnosed by our podiatrists during your biomechanical assessment with us. Sesamoiditis has key distinguishing features that we look for that can separate it from other causes of pain at the ball of the foot like capsulitis, bursitis, plantar plate tears and more. If we’re concerned about a fracture to your sesamoid bone, are concerned about multiple conditions affecting the ball of your foot at once, or need to investigate further, we may refer you for ultrasound or x-ray imaging.

How To Treat Sesamoiditis

After we confirm your sesamoid injury and get an understanding of why it has occurred from your extensive biomechanical assessment paired with getting to know your habits and lifestyle, our podiatrists will prescribe a custom treatment plan for you. As with any forefoot pain, there are three stages to treating sesamoiditis: relieving your initial symptoms, supporting the damaged structures to heal and make a full recovery, and finally keeping you pain-free by putting the right measures in place to help reduce the risk of the problem returning in the future.

We follow evidence-based guidelines for treatment to help you get the best results for your foot pain, and pair this with the range of innovative solutions we have uniquely available at our clinic. Your treatment plan may involve a combination of:

• Footwear advice or modifications: we want to ensure that both your daily and sport-related footwear is supporting your recovery instead of contributing to the development or perseverance of your sesamoid pain. If you need new running shoes, we’ll make recommendations on the best style for your foot type and foot posture.
  
• Laser treatment: laser treatment is a proven, painless and safe way to treat a range of foot pains while reducing inflammation, promoting wound healing and supporting soft tissue repair. Based on your symptoms and presentation, laser may be indicated in helping accelerate your recovery from sesamoid injury.
  
• Custom foot orthotics: orthotics are fantastic devices that replace the innersole of your shoe. We find them incredibly beneficial for sesamoiditis, with patients noticing instant relief by creating a drop-down area beneath the big toe that offloads the sesamoids. Your orthotics will also be custom designed to support optimal gait and reduce the likelihood of sesamoiditis recurrence in the future.
  
• Immobilsation with a boot: in severe cases where we suspect that you have a significant sesamoid fracture, we may need to use a moon boot or CAM walker to best support your healing and repair
  
• Stretching and strengthening program: many contributing factors to forefoot pain include tightness of weakness in the muscles and tissues. Part of your assessment always looks at whether any discrepancies are present, and then addresses them appropriately
  
• Temporary offloading or padding: by placing temporary felt padding inside of your shoes, particularly beneath the big toe, we can help instantly offload the sesamoids and give you relief from your very first appointment while your custom orthotics are being made.
  

How To Prevent Sesamoiditis

The best way to help prevent sesamoiditis is to follow good care principles for your feet and legs: wear good supportive shoes and replace sports shoes regularly, avoid high heels, complete stretching and strengthening exercises for your feet, and don’t ignore small pains and niggles in your feet - get them sorted before they turn into a full blown injury.

FAQs

Can sesamoiditis heal on its own?

Mild cases of sesamoiditis may heal on their own if the causative factors are addressed - the big toe is no longer overloaded and the area has a chance to heal. We often see people who have put up with their pain for weeks with no relief, and so need help to rehabilitate the injury.

Where are the sesamoid bones located?

Immediately beneath the big toe joint at the ball of the foot.

How long does sesamoiditis take to heal?

Once you start treatment, it can take between 2-8 weeks in our experience to get to a completely pain-free state. With this said, we expect significant improvements in your pain and comfort during regular walking from your first appointment where we apply some off-loading padding, and then even more so once you get your custom foot orthotics.