29 Jul Sesamoiditis
In this blog we are deep diving into sesamoiditis. What are sesamoids? What is sesamoiditis? What causes it? How do we treat inflamed sesamoid bones? Keep reading to find out!
What are sesamoids?
The sesamoids are two (usually two) small bones at the base of the big toe. These small bones are embedded in tendons. The role of the sesamoids is to increase the amount of upward bend (flexion) of the big toe. The big toe bending in this way provides propulsion during gait, running, springing etc. The role of the sesamoids is much like that of the kneecap (patella) which allows for greater flexion of the knee. Due to their location and function, the sesamoids are subject to great pressures during walking, running, dancing and other weight baring activities where the big toe plays a role in balance or propulsion.
What is sesamoiditis and what causes it?
Sesamoiditis is caused by an increase of pressure to the sesamoid area which, over time, results in an “overuse” injury. The sesamoids can also be injured by a sudden trauma such as a fall, landing badly from a jump etc.
Increased pressure to the sesamoid area may be a result many factors including wearing high heels, altered foot and/or lower limb biomechanics, certain foot types such as flat feet, high arched feet, bunions, protruding foot bones, increase in certain types of activity to name a few.
The result is inflammation and irritation of the tendons which encase the sesamoid bones (which can be described as a form of tendonitis) or damage to the sesamoid bones themselves. Sesamoiditis usually begins gradually as pain in the “ball” of the foot, beneath the base of the big toe. It is often reported as a dull ache or throbbing, however the pain may in some cases feel quite severe which causes the sufferer to walk with a limp.
Injuries to the sesamoid area can range from mild discomfort of the tendon to a fracture of the bones themselves. Fracture to the sesamoid bones may occur because of a sudden trauma to the area, or as a stress fracture which occurs over time due to repetitive overloading.
The pain tends to be noticed when walking, dancing, running or other high impact activities which engage the use of the joint of the big toe. The area will often be uncomfortable when palpated particularly when the big toe is bent upwards as this pulls the effected bones and tendon more tightly across the bottom of the foot. Some reddening to the area may be seen. The pain will often worsen over time.
Sesamoiditis assessment and treatment may vary depending upon the causes and history of the problem.
However, in almost all cases the treatment centres around alleviating the increased pressure to the sesamoid area. In most case orthotics can be effective in deflecting and redistributing pressures away from the sesamoid area by addressing the biomechanical factors (including foot shape and age-related changes to the foot) which have led to the increased pressure at the joint of the big toe.
In addition to orthotics, a review of footwear with recommendations and advice around short term activity modification to help speed up recovery to get back to enjoying walking, running, dancing etc as soon as possible.
In most cases sesamoiditis can be resolved once the factors causing the problem are identified and addressed.
Post by: Podiatrist Donna Davies