Sesamoiditis is a fairly common foot condition that causes forefoot pain, typically in young people who engage in physical activity like running or dancing. Its most common symptom is pain in inner side of the forefoot. The term is a general description for any irritation of the sesamoid bones, which are tiny bones within the flexor tendon that runs under the big toe. Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe the sesamoids are involved, and eventually they can become irritated, even fractured. Because the bones are actually within the tendons, sesamoiditis is really a kind of tendinitis – the tendons around the bones become inflamed as well. You have two sesamoids and may have one or both that are inflamed.
Sesamoiditis typically can be distinguished from other forefoot conditions by its gradual onset. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. It may build to an intense throbbing. In most cases there is little or no bruising or redness. One of the major causes of sesamoiditis is increased activity. You’ve probably stepped up your activity level lately, which has forced you to put more pressure on the balls of your feet. Speedwork, hillwork, or even increased mileage can cause this. If you have a bony foot, you simply may not have enough fat to protect your tender sesamoids. Sometimes trauma can initiate symptoms. Factors such as the size of the sesamoid bones, the weight, the particular foot structure, activities, the type of shoe the patient is wearing can all contribute to the inflammation of the sesamoid bones.
Treatment and Prevention
Treatment for sesamoiditis is almost always noninvasive. Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot. In addition, the big toe may be bound with tape or athletic strapping to immobilize the joint as much as possible and allow for healing to occur. Custom made orthotics are good for long term control and prevention to help compensate for mechanical faults and like most pathologies your podiatrist needs to evaluate precisely the cause of the problem to decrease these abnormal forces and heal the inflamed sesamoid.