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Nov 16, 2007 - SesamoiditisBack
SESAMOIDITIS
Definition:
Sesamoiditis is a condition that affects the forefoot, typically in young people who engage in physical activity like running or dancing.
However, it can present in people of any age and occupations who have a particular foot type which leads to excess pressure and trauma under the sesamoid bones of the foot. Symptoms include pain in the ball-of-the-foot, under the big toe joint but may later include the outer border of the foot as you compensate and overload other areas. Sesamoiditis is a general description for any irritation of the sesamoid bones.
Sesamoids are tiny bones situated under the big toe joint within the tendons that run to the big toe. Like the kneecap, the sesamoids function as a pulley, increasing the leverage of the tendons controlling the big toe. Every time you push off against the toe the sesamoids are involved. Eventually they can become irritated and in cases of direct trauma may even fracture. Because the bones are actually within the tendons, sesamoiditis can include a kind of tendonitis - the tendons around the bones become inflamed as well.
Cause:
Sesamoiditis can be distinguished from other forefoot conditions by its gradual onset and by the fact that it is located under the big toe joint. The pain usually begins as a mild ache and increases gradually as the aggravating activity is continued. It may build to an intense throbbing. In most cases there is little or no bruising or redness evident superficially.
One of the major causes of sesamoiditis is increased activity whereby additional stress has been added to the areas under the big toes. Speed work, hill work, or even increased mileage can cause this. If you have a bony foot, you simply may not have enough fat pad to protect your tender sesamoids. Also, if you have a high arched foot, you will naturally run on the balls-of-your-feet, adding even more pressure. The only exception to this is when there is a fracture of the sesamoid or extreme trauma – in this situation pain will be sudden and acute, but will come with a clue about a recent traumatic event.
Treatment & Prevention:
Treatment for sesamoiditis is almost always conservative (non surgical). Minor cases call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. This may be accomplished by placing a metatarsal pad away from the joint so that it redistributes the pressure of weight bearing to other parts of the forefoot. In addition, the big toe may be bound with tape to immobilize the joint as much as possible and allow for healing to occur. It is recommended to decrease or stop activity for a while. This will give your sesamoids time to heal. You should apply ice to the area for 10 to 15 minutes after exercise, or after any activity that aggravates the area. As with icing, anti-inflammatory medication will help the swelling go down so healing can begin. While the injury is healing, you should wear flat or lower heeled footwear on a daily basis. Shoes with extra shock absorbing characteristics will also be helpful.
Moderate to severe case or those that fail to respond to above measures often require prescription orthoses. The design of the orthoses will incorporate motion control and effective redistribution of pressure from under the sesamoids.
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