Sesamoiditis and sesamoid fractures Causes, symptoms and treatment
Sesamoiditis is painful inflammation affecting the one or both of the sesamoid bones, which are located in the forefoot under the big toe joint.
It is a reasonably common condition that typically affects physically active young people and adults. Sesamoiditis causes inflammation and pain in the ball of the foot, especially on the inner (medial) side. The pain may be constant, or it may occur with or be aggravated by, movement of the big toe joint. It may be accompanied by swelling (oedema) throughout the bottom (plantar aspect) of the forefoot.
Left untreated, sesamoiditis can progress further and lead to a fracture, which can be a more serious problem to manage.
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).
Some people also have an abnormality in their forefoot anatomy that causes the 1st metatarsal bone to sit relatively lower that the other metatarsal bones, causing greater amounts of pressure to pass into the sesamoid bones.
Diagnosis and Non-Invasive Treatment
Symptoms typically begin as a mild ache under the big toe joint, and gradually increases if the area continues to be aggravated.
Diagnosis is usually based on clinical examination and the pain's gradual onset. X-rays and sometimes MRI scans are used to exclude a fracture or more serious damage within the bone.
Initial treatment is non-invasive and includes activity modifications, shoe or shoe insole alterations, or orthotics to redistribute force and pressure away from the sesamoid bone. Oral anti-inflammatory medications and ice can assist to reduce swelling.
Advanced Treatment Options
For severe cases, along with any sesamoid fractures, a walking cast (moon boot) may be necessary for several weeks to heal this issue. Sometimes adjunctive steroid injections into the inflamed joint are also recommended.
Foot orthoses are often prescribed to correct underlying functional foot issues that cause the sesamoid bone to receive too much pressure, 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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