What is Sesamoiditis?
Sesamoid bones are commonly found in and around joints. Sesamoiditis is a painful inflammation of the region surrounding the sesamoid apparatus. While sesamoid bones can be found around any joint in the foot, they are consistently found within the joint of the great toe. Sesamoiditis affects the forefoot, typically in young people who engage in physical activity like running or dancing.
Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, sesamoiditis is really a kind of tendinitis – the tendons around the bones become inflamed as well.
Sesamoiditis is usually caused by repetitive, excessive pressure on the forefoot. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. If you have a bony foot, you simply may not have enough fat on your foot to protect your tender sesamoids. Other risk factors include: running, jumping from a height, ballet dancing, wearing of high heels or shoes with little cushioning and high-arched foot type.
With early and appropriate treatment, the condition often improves. Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot.
More resistant cases of sesamoiditis may be helped by an occasional cortisone injection. Long-term therapy must be geared to identifying the cause of the sesamoiditis so as to avoid these situations or to accommodate foot deformities or modify shoes. This may include the use of orthotic devices.
Sesamoid fractures require a more aggressive course of treatment because of the high risk of non-union. Cast immobilization for 6-8 weeks is the initial treatment of choice. The patient should then be advanced gradually to full weight bearing with a removable brace.