sesamoiditis

Below is a skeletal model showing the location of the sesamoid bones. The first view is of the foot coming towards you. The green arrow is pointing towards the lateral sesamoid, while the blue arrow is pointing towards the medial sesamoid. The second view is a side view. See how the sesamoid bones are directly underneath the first metatarsal bone. Also note that the higher the arch of a foot, the more pressure there is on the sesamoid bones.

The problem with these bones is their location. As you can see from the picture, they are located directly underneath a major weight bearing area of the foot.





Because of this they are prone to pressure and trauma. Factors such as the size of the sesamoid bones, the weight of the patient, the particular foot structure of the patient, activity of the patient and the types of shoe the patient is wearing can all contribute to the inflammation of the sesamoid bones.

Typically the symptoms range from a dull ache to a sharp pain every time the patient walks. The affected area may be swollen and slightly red. Bending the big toe upwards will generally cause the pain to worsen. The onset of symptoms can be gradual over a period of time with eventually the pain becoming so bad the patient has to seek treatment. Conversely, a day of walking in a very dressy shoe on the streets of Manhattan, for example, can set off the pain so that by the next day the patient is in a great deal of pain.

The area will be more painful barefoot on a hardwood or tiled floor and will feel a little bit better walking on carpeting or in a padded shoe such as a sneaker. People who wear very thin soled shoes and women who wear high heels will experience more pain because the thin sole does not protect the area and the lift of the foot from the high heel puts more pressure directly on the sesamoid bones.

When there has been a large amount of stress to the sesamoid bone there is also the possibility of fracturing the bone. At times it can be very difficult to make a diagnosis of a fractured sesamoid by x-ray alone and frequently either a bone scan or MRI will be ordered to confirm the diagnosis.

Because of their location injuries to the sesamoid bones can be very difficult to treat. In minor cases anti-inflammatory medication can be very helpful. Along with this the big toe has to be strapped in order to prevent it from bending upward. Additionally some kind of cushioned innersole has to be added to the shoe to protect the sesamoid bone from ground pressure. The patient needs to wear a good solid laced shoe and not flimsy dress shoes during the healing process.

In more severe cases a cortisone injection may be helpful for sesamoiditis but not for sesamoid fracture. If the above mentioned strappings do not help than the patient may have to wear a cast or in some very severe cases may have to go non weight bearing for a few weeks in an effort to keep all pressure off the sesamoids.

Looking for an effective, safe means to reduce or eliminate your foot pain, consider BLU-MJK. Use it in place of oral anti-inflammatory medication. Click the picture below

There are some situations that just do not seem to respond to the preceding therapies. At times the offending sesamoid can be removed surgically, however, that creates a multitude of potential problems. Since the bones are embedded in the tendons that help the big toe move, removing a sesamoid bone can adversely affect the function of the tendon and can cause the big toe to move either toward the second toe or away from the second toe thus creating instability in the great toe joint.

If the problem with the offending sesamoid is that it is too large or a bipartate sesamoid (double bone), particularly the sesamoid on the inside of the foot (medial), it can be shaved down without totally removing it.

People who are prone to this type of condition have to be sensible in their approach to shoe selection and activities. If you are going to insist on wearing shoes that exacerbate the problem, all the therapy in the world will not remedy the problem.

The same is true for those who may participate in an activity that forces the foot to excessively bend at the big toe joint. (stooping down while gardening for example) Those people must wear shoes that will cushion and protect that part of the ball of the foot. Many times I will prescribe an orthotic to counter the forces that are causing the sesamoiditis. Click here for more information on sesamoiditis and orthotics.