Do you have pain on the bottom of your foot right behind the joint of the big toe? If so, you may have damaged your sesamoid bones, or the tendons that surround them, resulting in a condition called sesamoiditis.
The sesamoids are two pea-shaped bones in the front of each foot – the forefoot – that most people are completely unfamiliar with until they’re injured – then they become keenly aware of them. Located just behind the big toe, these very tiny bones act like pulleys, providing a smooth surface over which the tendons glide, increasing the leverage of the tendons controlling the big toe. The sesamoids also assist with weightbearing and elevate the bones in your biggest toe.
Most bones in our bodies are connected at joints, but not so the type of bones known as sesamoids, which are connected only to tendons or embedded in muscle. Your kneecap is the largest sesamoid in your body, and the smallest are those found in the foot, assuming that you have them. Some are born without sesamoids in their feet, and experience no problems from their absence.
The forefoot is the main weight-bearing area of the foot and incurs the greatest amount of impact when we walk or run. Therefore, it’s also the most likely to be injured. Sesamoiditis is characterized by a dull, persistent pain below the big toe joint, in the ball of your foot. The pain typically begins as a mild ache and increases gradually as activity continues, building to an intense throb. In most cases, little or no bruising, swelling, or redness occurs.
Pain may be the result of a fracture of one or both of the sesamoids, or inflammation or irritation of the tendons surrounding them, which is referred to as sesamoiditis. Athletes are most likely to experience this condition, especially runners and baseball catchers, but it’s also common in dancers and those who are overweight or obese. However, any repetitive impact or trauma to the forefoot—including frequently wearing high heeled shoes—can cause it as well. In addition, people with high arches or inflexible feet are at risk for developing sesamoid problems because they naturally land on the balls of their feet when walking or running.
Sesamoiditis is a member of that group of injuries we refer to as “overuse injuries”, of which plantar fasciitis and achilles tendonitis are also members (in medical parlance, the suffix “itis” refers to “inflammation of a specified organ”).
If you’ have pain in this area of your foot, it’s important to discontinue the activity that caused the pain. Start with rest, icing, elevation, and pain medication if necessary. If pain and tenderness does not subside in a few days with this treatment, a visit to your podiatrist is in order. Your foot will be examined and x-rayed to determine the extent of your injury and to see if more aggressive treatment is required.
The good news is, most cases of sesamoiditis can be resolved without surgery. Proper rest, immobilization, ice, and over the counter medicines like advil or aleve to reduce inflammation and pain will usually relieve symptoms.
Initial treatment for sesamoiditis
- Stop the activity which caused the pain
- take over the counter pain medicine
- rest and ice the bottom of your foot twice a day
- to take the weight off your forefoot, wear soft, well-supported flat shoes like athletic shoes instead of high heels or dress shoes
- use an over the counter felt pad inside your shoe to cushion the affected foot
If pain persists, your podiatrist may recommend
- custom made orthotics to take the weight off of the forefoot
- steroid injections to relieve swelling and pain
- immobilization with a surgical boot
- padded socks
- physical therapy
- strapping or taping the big toe
If you believe you have pain in the sesamoid region, call PA Foot and Ankle Associates as soon as possible. Early intervention leads to the fastest cure.