Sesamoiditis

What is sesamoiditis?

Sesamoiditis is a specific kind of tendonitis — inflammation of the tendons — that occurs in the ball of the foot. Because the tendons in the ball of the foot have small sesamoid bones embedded in them, these bones can become inflamed along with the tendons. The two pea-sized sesamoid bones sit under the big toe joint, where they provide leverage when the tendons load weight onto the ball of the foot. Activities that frequently transfer weight to the ball of the foot — including running, dancing and walking in high heels — can overstress these tendons and bones, causing inflammation and pain.

How does sesamoiditis occur?

While most bones in the body are connected to other bones, sesamoid bones are unique in that they are only connected to tendons. They interact with the tendons as they move and are subject to the same stress from the same movements. Sesamoid bones exist in the feet, hands and knees, but sesamoiditis always refers to the foot bones. These bones bear the additional stress of shock absorption from walking. The sesamoid closer to the middle of the foot, the medial sesamoid, bears more of this stress and is more often affected, but the tibial sesamoid can be affected too.

What causes sesamoiditis?

Sesamoiditis is usually caused by overuse of the tendons that interact with the sesamoid bones in the foot. Runners, dancers and athletes get it from over-practicing movements that transfer weight to the ball of the foot. People who wear high heels, who have very high arches or very flat feet or who walk with an inward roll can get it just from walking. Rarely, it can also be a side effect of gout.

What are the symptoms of sesamoiditis?

Sesamoiditis from overuse develops gradually. You may notice a dull ache under the big toe that builds until it becomes difficult to walk. Symptoms can include:

• Pain under the big toe.
• Difficulty bending the big toe.
• Difficulty bearing weight or walking.
• Swelling.
• Redness.
• Bruising.

Who is at risk for sesamoiditis?

Anyone can get it, but people whose regular activities cause more repetitive stress to the tendons and sesamoid bones in the feet are more prone to get it. This includes:

• Dancers.
• Runners.
• Athletes.
• People who wear high heels.
• People with high arches.
• People with flat feet.
• People who walk with a slight inward roll of the foot (overpronation).
• People with gout.

How is sesamoiditis diagnosed?

Your healthcare provider will ask you about how the pain started and then begin by physically examining the foot. They will gently check for tenderness in the ball of the foot and move your big toe in different directions to test your mobility. They might use a technique called the Passive Axial Compression test that manipulates the joint in a similar way to walking in order to reproduce the symptoms of sesamoiditis. They might also use imaging tests to confirm or rule out certain related conditions.

Your sesamoiditis could be accompanied by a stress fracture, a small crack in the bone caused by repetitive stress. If your healthcare provider suspects an acute injury, they might want to screen you for an acute bone fracture or turf toe, an injury of the soft tissue around the sesamoid bones. If you’ve previously injured your big toe joint, they might want to rule out hallux rigidus, a kind of degenerative arthritis that affects that joint. Imaging tests might include X-ray, bone scan, CT scan, ultrasound or MRI.

How is sesamoiditis treated?

• Rest. Sesamoiditis is a repetitive stress injury, so the first thing to do to begin healing is to stop the activities that are causing the stress. You will need to keep pressure off of the injury until symptoms ease.
• Restriction. Your healthcare provider might recommend temporarily strapping or taping the big toe. For more severe cases, they might suggest a short leg fracture brace to restrict movement.
• Ice and elevation. These are used to help reduce inflammation. Use ice indirectly, either in an ice pack or wrapped in a towel.
• Soft tissue therapy. Your healthcare provider may use therapeutic ultrasound, moist heat or soft tissue massage to help rehabilitate the tissues.
• Physical therapy. If your foot has been restricted by a brace or bandaging, your healthcare provider may recommend physical therapy afterward to restore range of motion.
• NSAIDs. These can help with inflammation and pain management. Your healthcare provider will help you determine if NSAIDs are right for you.
• Steroid Injection. In rare, severe cases, your healthcare provider might give you a steroid injection directly into the injured tissue to relieve pain and inflammation.
• Surgery. In rare cases of chronic sesamoiditis, when symptoms don’t resolve over time, surgery might be a last resort. Removing one (but not both) of the sesamoid bones can bring relief.

How long does it take to recover from sesamoiditis?

Sesamoiditis can be mild or severe, and recovery time depends on the severity. Mild cases may resolve within days, while more severe cases can take months. Surgery will prolong recovery time.

How can I reduce my risk of sesamoiditis?

• Wear comfortable shoes. Don’t cramp your toes in a narrow toe box or strain the ball of your foot with overly high heels if you do a lot of walking. Replace your sneakers when the cushioning wears down.
• Wear custom orthotics. This is especially important if your job involves a lot of weight-bearing on your feet, or if you have anatomical factors that contribute to sesamoiditis, such as high arches or flat feet. Orthotic footwear can help deflect pressure away from the big toe joint.
• Preventative therapy. When you know you’ve been stressing your feet, follow strenuous activities with rest, ice and elevation to keep inflammation down.

What’s the prognosis after treatment for sesamoiditis?

Most cases of sesamoiditis will begin to improve immediately when you stop the activities that were causing repetitive stress to the joint. The tricky part will be safely resuming those activities. 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 if it’s not allowed to fully heal, or if you wait too long to seek treatment. To avoid chronic sesamoiditis and permanent damage, stay aware, take your pain seriously and practice preventative care.

Do I have sesamoiditis or gout?

While sesamoiditis is caused by overuse, gout occurs due to a buildup of uric acid. Gout can affect any joint, but it commonly occurs in the big toe. In most cases, gout flare-ups begin suddenly while sesamoiditis pain is gradual. Keep in mind, however, that a proper diagnosis is necessary to determine which condition is affecting your toe.

Is sesamoiditis the same as turf toe?

No. Though both conditions affect the big toe, they are different in nature. Turf toe — medically known as a metatarsophalangeal joint sprain — is an injury that occurs when the big toe joint extends beyond its normal range. The pain develops suddenly and is usually accompanied by immediate pain and swelling. Conversely, sesamoiditis is a condition that results from overuse. Sesamoid pain usually develops gradually over time.

Can you break a sesamoid bone?

Yes. It’s possible to fracture a sesamoid bone. This is usually caused by a direct blow to the foot, though it can also be due to repetitive stress. Treatments for a broken sesamoid bone may include:

• A cast or splint to keep the bone stable as it heals.
• Medications to ease inflammation and discomfort.
• Crutches to take weight off of your foot.
• Physical therapy exercises to gain strength and improve range of motion.

A note from Cleveland Clinic

Sesamoiditis can sneak up on you. It might start as a vague ache and then one day erupt into intense throbbing pain. Repetitive stress injuries like sesamoiditis occur when we ignore our body’s smaller stress signals until it decides to crank up the volume. When it gets to that point, we’ll regret it — especially if it means a long recovery period avoiding our usual activities. Take the health of your feet into your own hands by practicing preventative care. Pay attention to pain signals, and give your feet a rest after working them hard. When pain persists, seek treatment right away. Getting off your feet sooner will help you get back on your feet sooner.