What is Sesamoiditis?
In the foot, the sesamoid bones normally lie just beneath the big toe joint. They run in a tendon that flexes the toe down and their normal function is to stabilise the big toe joint and to give additional power to toe flexion. The two sesamoid bones form a joint with the end of the first metatarsal. Inflammation of these two bones is termed Sesamoiditis.
What are the symptoms of Sesamoiditis?
Pain on the undersurface of the foot, at the level of the big toe joint, is the commonest symptom. This pain is normally worse when pressure is applied to the area or when the doe is lifted up away from the floor. These actions apply pressure to the sesamoid bones as they come into close contact with the end of the first metatarsal bone. The causes are normally trauma, either acute or repetitive (such as long-distance running), unsupportive footwear or overload of the forefoot due to tightness in the calf muscle.
How is Sesamoiditis diagnosed?
History and clinical examination are key to determining the underlying diagnosis. X-rays can often appear normal so the best imaging modality is MRI.
What are my options for treatment?
Once the diagnosis and causation have been confirmed, treatment options can be considered. Avoiding the underlying cause is obviously important. Simple rest and abstaining from stressing the bones can be all that it required. For more persistent symptoms, an orthotic to offload the sesamoids can give excellent symptom relief and allow the bones to recover. Injection to the big toe joint can provide an anti-inflammatory effect which can also break the cycle of irritation and pain. Surgery is rarely required and has comparatively poor outcomes.