Sesamoiditis

Sesamoiditis is a common cause of pain in the ball of your foot (metatarsalgia). Your sesamoids are two tiny bones embedded in the tendons in your forefoot, just under your big toe joint (first metatarsal joint). These bones help absorb shock and stress when you put weight on your foot. Sesamoiditis means one or both of these bones are irritated and inflamed, along with the tendons they’re embedded in.

This makes sesamoiditis kind of an enhanced type of tendonitis, with small bones inflamed inside your tendons. Foot tendonitis is usually a repetitive strain injury, and sesamoiditis is no different. It usually happens gradually, from activities that put repetitive stress on your sesamoids. Frequent running, dancing or walking in high heels are common causes. Your foot will need time and rest to recover.

Symptoms of sesamoiditis

Sesamoiditis symptoms may include:

• Foot pain in the ball of your foot, under your big toe
• Difficulty bending your big toe
• Difficulty putting weight on the ball of your foot
• Local swelling and tenderness to touch

Sesamoiditis usually develops slowly. You might notice a dull ache under your big toe that builds or gets sharper over time. You’ll notice it most when you’re using your foot, and it might go away at other times.

Sesamoiditis causes

Repetitive strain on one or both of your sesamoid bones usually causes sesamoiditis. Runners, ballet dancers and athletes get it from over-practicing movements that transfer weight to the balls of their feet. If you often wear high heels, or you have high arch feet or bunions that affect how you walk, you might get it from walking. Occasionally, other diseases or conditions can lead to sesamoiditis, such as:

• Gout
• Osteoarthritis
• Osteoporosis
• An injury to your big toe joint

When you put weight on the ball of your foot, tendons in your foot flex to bear the weight and perform different movements. On the big toe side, these tendons glide over your sesamoid bones when they move, using them for leverage. So, strain on these tendons directly affects your sesamoids. Weight and force can also affect the bones directly. In severe cases, repetitive stress can cause a stress fracture.

How do doctors diagnose sesamoiditis?

To diagnose sesamoiditis, a healthcare provider will ask about your symptoms and then carefully examine your foot. They’ll look for signs of tenderness and inflammation around your sesamoid bones. They’ll gently move your big toe joint to see if movement causes pain. They might also move the joint in a way that simulates how it works when you’re walking. This is called the passive axial compression test.

Your provider might want to take imaging tests of your foot to check for a fracture or other injuries.

These tests might include:

• Foot X-rays
• Bone scan
• CT scan
• MRI

What is the treatment for sesamoiditis?

Treatment for sesamoiditis mostly consists of rest and self-care. You might benefit from some hands-on therapy techniques. Severe or chronic sesamoiditis might need additional medical or surgical care.

Your treatment plan may include:

• Rest: You’ll need to take stress off your foot until the bones and tendons can heal. Your provider might recommend using crutches for a while.
• Restriction: Your provider might suggest strapping or taping your big toe or bracing your ankle to restrict movement while your foot heals.
• Ice and elevation: Applying ice and elevating your foot for short intervals can help reduce inflammation, swelling and pain.
• Pain relievers: Your provider might recommend nonsteroidal anti-inflammatory drugs (NSAIDs), anti-inflammatory pain relievers that you can get over the counter.
• Steroid injection: For severe pain and swelling, your provider might suggest a one-time steroid injection into the sore spot.
• Orthotics: As you gradually return to activity, your provider might suggest special orthotic shoes or inserts to relieve pressure on your sesamoids.
• Physical therapy: After restricting your foot, your provider might recommend physical therapy to restore its range of motion.
• Surgery: If other treatments don’t relieve sesamoiditis, your provider might suggest surgery to remove the irritated sesamoid (this is rare).

What can I expect after treatment for sesamoiditis?

In most cases, sesamoiditis should begin to improve immediately when you stop putting stress on that part of your foot. Rest gives your tissues the chance to repair from damage. Mild cases may resolve within days, while more severe cases may take months to fully heal. It’s rare to need surgery for sesamoiditis. But if your symptoms fail to improve with time and care, surgery can bring relief.

The tricky part will be to safely resume the activities that caused sesamoiditis. Follow your healthcare provider’s guidance on this, as well as your own body signals. Sesamoiditis can always occur again. It can also do permanent damage to your bones and tendons if you don’t allow it to fully heal or if you wait too long to seek treatment. You can avoid this by listening to your body and practicing preventive care.

What can I do to prevent sesamoiditis from occurring or returning?

If you’re prone to sesamoiditis, you can reduce your risk by reducing the factors that contribute to it.

For example:

• Wear comfortable shoes. Especially if you walk a lot, it’s important to wear supportive shoes. Don’t cramp your toes in a narrow toe box or wear too-high heels. Replace worn-out sneakers.
• Consider custom orthotics. If you have anatomical differences in your foot, they might put extra stress on your sesamoids. An orthotist can make custom orthotics to compensate for it.
• Pay attention to pain. If you’re an athlete or dancer, you may be in the habit of ignoring pain from everyday practice. But it’s important to recognize and treat pain that doesn’t go away.
• Treat pain preventively. If you know you’ve been stressing your feet, take extra care of them. Follow a period of strenuous activity with a period of rest, ice, compression and elevation.