Do you have pain underneath your big toe? Has the dull ache you’ve had for years worsened lately and you can no longer just put up with the pain? If you answered yes to these questions, then you may be suffering from Sesamoiditis.
What is Sesamoiditis?
At the base of your big toe, near the ball of your foot, there are two small pea shaped bones. These bones are called the Sesamoids, which are embedded into the tendons of the flexor hallucis brevis muscle.
This allows for the a smooth surface for the tendons to glide over and move the big toe. Sesamoiditis involves inflammation and irritation of these bones and the tendon.
What Does Sesamoiditis Feel Like?
Cases of sesamoiditis pain have been described as:
- A sharp and intense pain when walking or running
- A dull ache at rest
- Pain that is intermittent
- A constant ache with each step
What Causes Sesamoiditis?
Sesamoiditis can be caused by a range of factors, including:
- Overuse – Sports which involve repetitive jumping and pivoting through the big toe joint, such as volleyball, basketball, golf, ballet, and so on, can result in overuse and damage of the sesamoids and flexor hallucis brevis tendon over time.
- Footwear – Those who frequently wear high heeled shoes are more susceptible to sesamoiditis. This is because high heeled shoes place a direct force through the sesamoids. Shoes that have a thin and flexible sole, like ballet flats, can also be a contributing factor to sesamoiditis. This is because they provide minimal to no shock absorption from the shoe when walking.
- High Arches/Pes Cavus Foot Type – People with high arches in their feet are typically more likely to get sesamoid injuries. This is because the sesamoids, along with the heel and base of the 5th toe are in contact with the ground and absorb the shock when walking.
Who Does Sesamoiditis Affect?
Sesamoiditis can affect anyone in the population, but is more common amongst adults who:
- Suffer from osteoporosis or osteoarthritis
- Have high arched (pes cavus) foot type
- Participate in high impact activities including running and ballet
- Have bunions or a rigid foot type
How is Sesamoiditis Diagnosed?
When diagnosing sesamoid injuries, we will passively move your big toe up and down and gently press against the sesamoids to replicate the pain. An assessment of your footwear will also be conducted, as those suffering with sesamoiditis will often find that their shoes or insoles are wearing out underneath their big toe.
Looking at the way you walk may indicate that there is a large increase in pressure over your sesamoids and this can be shown to you on our Zebris treadmill. Through doing these assessments a greater understanding of the contributing factors to the pain in your foot can be made clear.
An X-ray of the sesamoids is often required to fully understand the extent of the injury and whether or not a fracture is present. It is possible that you may be referred for an MRI if the X-ray does not appear to show any damage.
Fracture Sesamoid vs Sesamoiditis
The sesamoid bones in your foot can be fractured and have a similar presentation to sesamoiditis. Obtaining the correct diagnosis of these two conditions is important in order to help guide your management plan.
Sesamoiditis typically presents as an ache that gradually worsens with activities such as running and jumping when the toe is repetitively loaded and moved. There can also be localised swelling or bruising through the ball of your foot and pain when straightening the toe.
Alternatively, it is possible that you have sustained a fracture to the sesamoid. This usually occurs with an event such as a hard landing from a jump and is associated with intense pain. When assessing for a fractured sesamoid, the pain on direct palpation will be extremely painful. Imaging of your foot will likely be requested to confirm the diagnosis of a fracture.
How is Sesamoiditis Treated?
Sesamoiditis can be successfully treated with a combination of these non operative measures.
- Rest and ice – Keeping off your foot and slowly returning back to activity will help to avoid reinjury. Applying ice to the sesamoids can assist in reducing the inflammation that may be present on the ball of your foot.
- Taping – Taping is designed to limit the amount of motion through a joint. In cases of sesamoiditis, we tape the toe into a neutral position to immobilise the joint and reduce the amount of pressure in the area. This also reduces the prominence of the sesamoids on the bottom of the big toe, also reducing the pressure.
- Offloading with Padding – We may use felt padding on the foot with a cut out over the sesamoids to offload the area when you are walking. This is commonly used prior to orthotics to mimic the function of the potential orthotic insert.
- Orthotics – Modifying the position of your foot and improving the overall foot function is helpful in sesamoiditis. Soft padding can be built into the orthotic directly under the sesamoids whilst also correcting the position of your foot. The big toe joint is integral during gait, therefore facilitating its function will reduce the pressure placed on the sesamoids.
- Change in Footwear – Purchasing new footwear can help in the management of the pain if you are wanting to keep running or walking. The features of a shoe that would be recommended for your foot would be one with a low heel to lessen the force on the sesamoid bones and a soft sole that will allow for cushioning and shock absorption.
- CAM/Moon Boot – Immobilisation of the foot with a moon boot or removable cast will effectively offload the sesamoids completely and allow you to continue to walk around. This cast will typically stay on for 4 – 6 weeks whilst the area heals.
- Surgery – In some cases surgery is required if conservative treatment options are unsuccessful or not suitable for your injury.
The team here at Watsonia Podiatry are here to help you get back on your feet and help you with your recovery from sesamoiditis and prevent the pain from coming back.
You can give us a call on 03 9432 2689 or book online here for you appointment.