Many different conditions can affect the health of your feet. If you’re someone who spends a lot of time on your feet, you may be used to a dull, aching sensation. If that pain prevents you from walking, it could be caused by overuse of the feet leading to a condition called sesamoiditis.
What Is Sesamoiditis?
Most of the bones in your body are connected to other bones, but bones classified as sesamoids are not. Instead, they are either connected to tendons or embedded within your muscles. Your hands, feet, and knees all contain sesamoid bones.
Sesamoiditis is a type of tendonitis. Tendonitis occurs when tendons become inflamed and irritated. In cases of sesamoiditis, this inflammation affects the tendons surrounding the sesamoids in the feet. While there are a few sesamoids in the foot, sesamoiditis specifically refers to inflammation surrounding the sesamoids in the ball of the foot under the big toe joint, though other sesamoids in the foot may also be affected.
Sesamoiditis typically progresses gradually due to overuse of the tendons in the foot. It most commonly affects dancers, runners, and other athletes. These types of activities put repetitive stress on the tendons in the foot and the balls of the feet.
Some foot conditions or habits can make you more prone to sesamoiditis. These include:
- Having flat feet
- Having high arches
- Having an inward roll to the foot
- Frequently wearing high heels
Sesamoiditis can also be a side effect of a type of arthritis called gout. Gout is caused when your body produces too much uric acid, a byproduct of the body breaking down food and drinks. When this happens, uric acid crystals build up in the joints. The big toe is the joint most commonly affected, but this condition can also affect joints like the ankle, elbow, knee, and wrist.
The most common and obvious symptom of sesamoiditis is pain in the ball of the foot: specifically, under the joint of the big toe. This pain may slowly build until it becomes too painful to walk. On the other hand, if a fracture in the bones accompanies the sesamoiditis, the pain will be immediate.
Other common symptoms of sesamoiditis may include:
- Trouble bending your big toe
- Trouble bearing weight on the ball of the foot
- Trouble walking
- Stress fractures in the sesamoid bones due to overuse
In most cases, your doctor will begin with a physical examination of your foot, checking for tenderness and testing your mobility. Your doctor may perform a Passive Axial Compression test. This test manipulates the joint to mimic the movement of walking in order to test for the symptoms of sesamoiditis.
Many conditions, such as turf toe or certain types of arthritis, can mimic sesamoiditis. To rule out these conditions, your doctor may request imaging tests. This also allows them to check to see if your sesamoiditis includes a stress fracture in the sesamoids. The imaging tests that your doctor orders may include:
- X-rays: X-rays use electromagnetic radiation to produce images of bones and collections of dense tissue. This allows your doctor to check for fractures in the sesamoid bones.
- CT scan: CT scans use a series of X-rays to create a 360-degree view of an area of the body. This is another way your doctor can check for fractures.
- MRI: Magnetic resonance imaging (MRI) uses a large magnet and computer-generated radio waves to produce detailed images. Your doctor may use an MRI to look for inflammation of the tendons and abnormalities within the toe joint.
- Ultrasound: Ultrasounds use soundwaves to produce images of the inside of the body. They are commonly used in pregnancy but also as a diagnostic tool. Ultrasounds allow your doctor to monitor the joints and tendons while they move.
- Bone scan: Bone scans are a way for your doctor to get a closer look at your bones. A small amount of radioactive tracer is injected into your body, and a special camera is used to find differences in bone metabolism, allowing your doctor to find bone infections or injuries that may not show up on an X-ray. While a bone scan may sound scary, the amount of radiation exposure is negligible and less than that of a CT scan.
Many different things may factor into the treatment plan your doctor chooses for your sesamoiditis. They may consider the cause and severity of the sesamoiditis and whether your sesamoiditis is accompanied by any other conditions, including bone fractures.
Rest. Regardless of what caused your sesamoiditis, your doctor will likely recommend that you keep pressure off your injured foot for some time to allow the injury to heal. If the sesamoiditis is caused by an activity that puts prolonged stress on the balls of your feet, such as dancing or running, your doctor may recommend that you take an extended break.
NSAIDs. Non-steroidal anti-inflammatory drugs, or NSAIDs, include over-the-counter medications such as aspirin or ibuprofen. NSAIDs can reduce pain and inflammation caused by sesamoiditis.
Elevation and ice. Your doctor may recommend elevating your foot or using ice to reduce swelling and inflammation. Never put ice directly on the skin, though. Instead, use an ice pack or wrap the ice in a towel.
Restricting movement. To prevent the big toe from moving too much and further irritating the tendons, your doctor may recommend taping the big toe. If you have a severe case of sesamoiditis, you may also need to wear a removable short leg fracture brace for approximately four to six weeks.
Steroids. For severe cases of sesamoiditis, your doctor may inject steroids into the irritated tissues to reduce inflammation and pain.
Surgery. Surgery is often used as a last resort for chronic sesamoiditis. In this situation, one of the two sesamoid bones in the ball of the foot is removed to offer relief.
Therapy. As you recover, your doctor may recommend physical therapy or soft tissue therapy. Physical therapy helps to restore the range of motion after your foot has been restricted. Soft tissue therapy helps restore the tissues of the foot.
Sesamoiditis Recovery Time
The recovery time for sesamoiditis will vary greatly from person to person. Factors that may affect the recovery time include the severity of the sesamoiditis and the cause of the sesamoiditis. Mild cases can clear up within a few days, while more severe cases may take several months.
Most cases of sesamoiditis will improve more quickly if you allow your foot to rest. Trying to jump back into physical activities too soon, on the other hand, can cause permanent injury. Follow your doctor’s instructions and your body's signals to allow your foot to heal properly and prevent future injury.