Understanding Sesamoid Pain

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor. Sesamoid pain can be very uncomfortable and felt during daily activities like walking. Especially in urban cities like New York repetitive walking and overuse can lead to inflammation pain in the tissue surrounding the joint.

Types of Sesamoid Injuries:

Turf Toe

This is an injury to the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the moment of injury.

Sesamoid Fracture

• An acute fracture is caused by trauma – a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint.
• A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.

Sesamoiditis

This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.

Diagnosing Sesamoid Pain

In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.

The offices at Drucker Podiatry have access to in-office CT and MRI machines making the initial consultation much more efficient. We are able to order the necessary imaging and work towards a diagnosis and treatment in a quicker manner.

Non-Surgical Treatment for Sesamoid Injuries

Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options depending on the type of injury and degree of severity:

• Padding, Strapping or Taping: padding may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension
• Immobilization: the foot may be placed in a cast or removable walking cast with or without the assistance of crutches
• Oral Medications: non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are often helpful in reducing the pain and inflammation

Physical Therapy for Sesamoid Fracture

• Physical Therapy: rehabilitation following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning) and ultrasound therapy

Sesamoiditis Cortisone Injection

• Steroid injections: cortisone may be injected in the joint to reduce pain and inflammation

Orthotics for Sesamoid Fracture

• Orthotic Sesamoid Devices: custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot

Surgical Treatment for a Sesamoid Fracture 

• Repair of ligaments, fracture, and joint capsule with sutures
• Fixation with internal hardware
• Removal of the affected non-healing bone