Pain under the big toe joint? It might be your Sesamoids.
If you’re suffering from pain under your big toe joint, there’s a chance it could be Sesamoiditis. We diagnose and manage Sesamoiditis at Foot & Ankle!
What is sesamoiditis?
Sesamoiditis refers to the pain, inflammation or irritation of the sesamoid bones and the surrounding tissue. Sesamoid bones are small, round bones located beneath the big toe joint. Most people have two sesamoid bones and they act just like a kneecap working like a pulley, providing leverage and stability to the big toe joint. They sit within tendon tissue, specifically within the flexor hallucis brevis tendon.
The sesamoid bones are located under the big toe joint.
What are the symptoms of sesamoiditis?
The common symptoms of sesamoiditis include:
Pain and tenderness under the big toe joint
Swelling and redness around the big toe joint
Difficulty and discomfort while walking or bearing weight on the foot
Limited range of motion in the big toe
Worsening pain when walking on hard surfaces or engaging in high-impact activities
How is sesamoiditis diagnosed?
At Foot & Ankle we can aid in the diagnosis of Sesamoiditis.
The following diagnostic tests can be useful:
Palpable pain of the sesamoid bones
Symptom pattern and history
X-rays, ultrasound or MRI scans
What causes sesamoiditis?
It is always a combination of factors that causes sesamoiditis. It can usually be best understood with the load versus capacity model. That is, the repeated load through the sesamoid bones, is greater than they can handle, which is triggering symptoms.
Some people are at high risk of sesamoiditis, and this is commonly linked to the following:
High arch foot type (generally places greater loads through the big toe joint and subsequent sesamoid bones)
Fat pad atrophy or a loss of cushioning under the sesamoids
Prominent or large sesamoid bones (thanks genetics!)
Everyone’s anatomy is different - sesamoid bone size is different for everyone.
How do you treat sesamoiditis?
The treatment of sesmoiditis is largely based around reducing load through the sesamoid bones to manage pain and symptoms. This can be achieved with a variety of methods, including the following:
Padding / big toe joint cut outs to reduce pressure through the sesamoids
Footwear / shoe modifications (stiff soled shoes or forefoot rocker shoes can help)
Heat / ice to manage symptoms
Consider reducing aggravating load such as walking, running, jumping
Orthotics (more on this below)
After the reduction in load (and symptoms) has been achieved, a gradual return to activity can begin. The speed of this return will depend on factors including pain levels, type of activity and symptom reduction.
Can orthotics help with sesamoiditis?
Yes, orthotics can play a role in managing sesamoiditis. Orthotic devices or shoe inserts can be designed to deload the sesamoid bones, and reduce the ongoing overload. They can allow for more specific offloading of the sesamoid bones (everyone is different), whilst also being able to create consistency by easily swapping the devices between your shoes.
How long does sesamoiditis pain last?
The duration of sesamoiditis pain will vary from person to person, depending on the severity of the condition and adherence to the treatment plan. With appropriate management, the average return to full activity is 8-12 weeks.
Can you walk or run with sesamoiditis?
As always - it depends! If symptoms are worsening with walking or running, the advice is generally to reduce volume. If there is appropriate offloading, and symptom improvement, (and you have clearance from your Podiatrist), you are able to continue walking or running.
If you think you have sesamoiditis, or need help with your sesamoiditis, we’re here to help!