Sesamoiditis

SesamoiditisWhen I am taking foot radiographs of my patients the first thing they see is two round small bones that are sitting on top of great toes and say ‘what are those little bones?  What is wrong with my foot?’ They are called sesamoid bones that are pea-shaped located at the base of the big toe.Sesamoiditis is an overuse injury involving inflammation of these little bones and is normally caused by increased pressure or loading on the sesamoid bones and associated tendons.

This pain is often associated with a dull, longstanding pain beneath the big toe joint. It comes and goes, usually occurring with certain shoes and/or aggravated by specific weight-bearing activities.

There are a number of forefoot pathologies that can present similarly to sesamoiditis, therefore identifying the particular cause and confirming the diagnosis of sesamoid pain can be challenging. X-rays may be needed and other advanced modern imaging techniques may need to be considered such as ultrasound or MRI. Conditions causing similar discomfort to sesamoiditis can include turf toe and sesamoid fracture. Turf toe is an injury to the soft tissue surrounding the big toe joint and usually occurs when the big toe joint is extended beyond its normal range.  A fracture in a sesamoid bone can be caused by direct trauma or impact on the joint. Getting the diagnosis correct is important to ensure the correct treatment is administered.

Treatment will depend on the diagnosis and degree of injury and may include immobilization, modification of footwear, and specific orthotics to offload the pressure around the sesamoids, Nsaids, and possible surgery if other treatment measures fail.

Sesamoiditis cannot be definitively cured, as there is always a risk of re-triggering it but it can be managed and prevented.

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