Sesamoiditis is an overuse injury that results in pain underneath the big toe.
The foot sesamoid bones are two small round bones that sit underneath the big toe within the tendon responsible for bending the big toe.
Sesamoiditis is a type of foot tendonitis where the sesamoid bones and the surrounding tendon become inflamed causing pain in the ball of the foot.
Anything that places repetitive pressure or stress on the big toe can lead to sesamoiditis, such as high-impact sports, tight footwear, foot injuries or muscle imbalance.
Here we will look at the common causes and symptoms of foot sesamoiditis, how it is diagnosed and the best treatment options.
Sesamoid bones are a unique type of bone. Most bones are connected to other bones at joints, for example the femur (thigh bone) and tibia (shin bone) are connected at the knee joint.
But sesamoid bones actually sit within a tendon and don’t connect to other bones. Sesamoid bones act as pulleys to reduce friction and enhance mechanical advantage by increasing leverage at the tendon.
In the human body, sesamoid bones are found in three places:
Sesamoiditis always refers to inflammation of the sesamoid bones in the foot and that is what we will concentrate on here.
The sesamoid bones of the foot are two small pea-sized bones that sit within the flexor hallucis brevis tendon, the tendon that runs underneath the big toe.
The foot sesamoid bones help to bear weight, provide stability, absorb shock, reduce friction and distribute the load when you walk, run, or engage in any activities that involve pushing off the ground with your toes.
These small bones play a crucial role in the function of the foot and are involved in various movements, especially in activities that require bending the big toe and supporting body weight.
Repetitive friction and pressure through the sesamoid bones leads to inflammation of the sesamoid bones and their surrounding tendon. This is known as sesamoiditis and is a type of foot tendonitis.
Sesamoiditis foot pain is typically caused by excessive or repetitive stress on the sesamoid bones and the tendons surrounding them. Common causes of foot sesamoiditis include:
Common symptoms of foot sesamoiditis include:
It's important to note that sesamoiditis symptoms can vary in intensity and may come and go.
Diagnosing sesamoiditis involves a combination of a physical examination, discussion of symptoms, and, in some cases, the use of imaging tests.
The process usually begins with a detailed medical history. Your healthcare provider will ask about your symptoms, when they started, and whether there was any specific event or activity that might have triggered the pain. Information about your physical activities, footwear, and any prior foot injuries is also relevant.
They will also conduct a physical examination of your foot. They will palpate the area around the big toe joint, specifically the ball of the foot where the sesamoid bones are located. The presence of tenderness and pain upon touch is a significant indicator of sesamoiditis. They will also assess the range of motion in your big toe to see if there is any restriction to movement. They may also assess the whole foot to rule out other possible conditions.
In some cases, to confirm the diagnosis and rule out other potential issues, you may be sent for imaging tests. The most common imaging tests used for diagnosing sesamoiditis include:
X-rays: can show the condition of the sesamoid bones and any abnormalities, such as fractures, dislocation, or degeneration. Sesamoiditis typically does not cause visible changes on X-rays, but these images are valuable for excluding other conditions.
Magnetic Resonance Imaging: an MRI may be recommended to provide a more detailed view of the soft tissues, tendons, and sesamoid bones. This helps confirm any inflammation or other soft tissue issues.
Bone Scan: will show any areas of irritation in the sesamoid bone.
Once the healthcare provider has gathered all the necessary information from the examination and imaging, they can make a definitive diagnosis.
While sesamoiditis is a common cause of pain in the ball of the foot, there are several other foot-related conditions that could have similar symptoms:
The treatment of sesamoiditis typically involves a combination of conservative measures aimed at relieving pain, reducing inflammation, and promoting healing. In most cases, surgical intervention is not necessary, and these non-invasive approaches can be highly effective.
Common treatment options for sesamoiditis include:
The success of sesamoiditis treatment often depends on early diagnosis and adherence to the recommended interventions. With proper care and rest, many individuals can experience significant relief from sesamoiditis and return to their regular activities without any foot pain.
Surgical intervention for sesamoiditis is typically considered a last resort and is not commonly needed unless conservative treatment methods have failed to resolve symptoms. There are a few different surgical options for sesamoiditis:
Sesamoid removal is the most common surgical procedure for sesamoiditis, aka sesamoidectomy.
During a sesamoidectomy, the problematic sesamoid bone is surgically removed.
This procedure is performed under local or general anaesthesia and is typically considered when all other treatments have proven ineffective, and the pain is significantly impacting the individual's quality of life.
Recovery: After a sesamoidectomy, a period of rest and immobilization is required to allow the foot time to heal. Crutches or a walking boot may be necessary for a few weeks. Physical therapy can help restore strength and flexibility in the foot. Over time, the foot adapts to the absence of the sesamoid bone, and most individuals can return to normal activities.
Possible Consequences: Removing a sesamoid bone can alter the mechanics of the big toe joint and the surrounding tendons. This procedure can lead to changes in gait and push-off power in the foot. Some individuals may experience stiffness or reduced strength in the big toe, which is why sesamoidectomy is reserved for severe and persistent cases.
In some cases, rather than removing the sesamoid bone, surgical repair may be attempted. This procedure is less common and typically involves stabilizing or repositioning the sesamoid bone or addressing damage to the surrounding structures.
Recovery: Recovery from sesamoid bone repair surgery may vary depending on the specific procedure performed. Similar to sesamoidectomy, rest, immobilization, and physical therapy are often necessary.
In extremely rare cases where all other treatments have failed and there is severe damage to the sesamoid bones and surrounding joints, fusion of the big toe joint (arthrodesis) may be considered. This procedure involves fusing the bones in the big toe joint to eliminate movement and reduce pain.
Recovery: Recovery from arthrodesis is more involved and can require an extended period of immobility and rehabilitation. After the procedure, you'll likely need to wear a cast, and weight-bearing may be limited for an extended time.
Sesamoiditis is a type of foot tendonitis caused by inflammation of the sesamoid bones and surrounding tendon.
Common causes of sesamoiditis include repetitive overuse, tight footwear, altered foot biomechanics, obesity and foot injuries.
Sesamoiditis often affects athletes who do activities such as running (especially sprinters), dancing, football and baseball (especially pitchers).
The function of a sesamoid bone is to increase leverage and improve mechanical advantage as well as reduce tension, absorb stress and redistribute weight-bearing forces.
Common symptoms of foot sesamoiditis include pain underneath the big toe, localised bruising and swelling, difficulty walking or running and stiffness in the big toe.
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Page Last Updated: 11/23/23
Next Review Due: 11/23/25