Dealing With Sesamoiditis: Causes, Symptoms, and Cures
Sesamoiditis is a painful inflammation affecting the two tiny, round sesamoid bones located beneath the joint of the big toe (hallux). It commonly affects physically active young people, causing persistent or aggravated pain in the ball of the foot, particularly on the inner (medial) side, sometimes accompanied by swelling across the forefoot.
Sesamoid Bone Function
The sesamoid bones are embedded in the flexor hallucis brevis tendon, acting as a crucial fulcrum. They provide a mechanical advantage for the big toe and, along with their ligament attachments, disperse impact forces during walking. This array of structures is known collectively as the sesamoid apparatus.
Causes and Progression
Sesamoiditis is primarily caused by repetitive, excessive pressure on the forefoot, frequently seen in ballet dancers and athletes in jumping sports like basketball. Chronic pressure irritates the joint structures, causing inflammation. Untreated cases can progress to stress fractures, true bone fractures, and potentially avascular necrosis (bone death).
Diagnosis and Non-Invasive Treatment
Symptoms typically begin as a mild ache and gradually increase. Diagnosis is usually based on clinical examination and the pain's gradual onset. Initial treatment is non-invasive and includes strict rest, modified shoes or pads to redistribute weight, and taping to immobilize the big toe joint. Oral anti-inflammatory drugs are used to reduce swelling.
Advanced Treatment Options
For severe cases, a walking cast may be necessary for several weeks, along with steroid injections into the inflamed joint. Foot orthoses are often prescribed to correct underlying functional foot issues, preventing recurrence. If chronic pain persists or if avascular necrosis is present, surgical removal of the painful sesamoid bone (sesamoidectomy) may be indicated.
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