Sesamoiditis is a condition that doesn’t always make it to the top of the foot care conversation but can have a big impact if left unchecked. The sesamoid bones, two small, pea-sized bones beneath the big toe joint, play a vital role in helping your foot function. They’re embedded in tendons and act like pulleys to help the big toe move up and down as you walk, run, or even stand.
When these bones or the surrounding tendons become irritated or inflamed, it leads to a condition known as sesamoiditis. And while it may seem like a minor issue, untreated sesamoiditis can cause long-term problems like chronic pain, stress fractures, and limited mobility.
Causes of Sesamoiditis
Understanding what triggers sesamoiditis is the first step in managing and preventing it. Here are the four primary causes:
1. Repetitive Activities
Certain activities put a lot of pressure on the ball of the foot. This repetitive stress can wear down the sesamoid bones over time, causing inflammation. For example, runners—especially those who land on their forefoot—often experience this. The same applies to ballet dancers who go en pointe, putting significant weight on the sesamoids with each step.
Prevention Tip: Wear cushioned shoes with proper arch support, and for dancers, proper technique and occasional padding in shoes can help.
2. High Heels
We’ve all heard the warnings about high heels. These fashionable footwear choices put the foot in a position that shifts weight forward onto the ball of the foot, putting excessive strain on the sesamoids. Over time, this continuous pressure can result in inflammation and pain.
Prevention Tip: Choose shoes with a lower heel and a cushioned insole to reduce the impact. When possible, alternate between heels and flats to give your feet a rest.
3. Foot Structure
Your natural foot structure can make you more prone to sesamoiditis. People with high arches, or those who overpronate, may find themselves putting extra weight on the ball of their foot. This can lead to increased pressure on the sesamoids and, eventually, inflammation.
Prevention Tip: If you have structural issues, custom orthotics are a great way to redistribute pressure and offer extra support to the foot.
4. Trauma
Injury to the foot, whether from a fall, or dropping something heavy on it, can lead to acute inflammation in the sesamoid bones. This trauma can cause immediate pain, bruising, and swelling.
Prevention Tip: While accidents are unavoidable, being cautious in environments like construction sites or places where heavy objects are moved can help. Wearing protective footwear in these environments is essential.
Symptoms to Watch Out For
Recognising sesamoiditis early can help avoid long-term complications. Here are the primary symptoms to look for:
1. Pain Under the Big Toe or Ball of the Foot
The pain typically starts as a dull ache but can turn sharp or throbbing over time. It tends to intensify with activities like running, walking, or standing for extended periods.
Relief Tip: Resting the foot and avoiding weight-bearing activities can provide temporary relief.
2. Swelling and Bruising
The area around the big toe joint may become swollen, and in some cases, bruising may develop, especially after an acute injury.
Relief Tip: Applying ice and elevating the foot can help reduce both swelling and pain.
3. Difficulty Moving or Bending the Big Toe
Inflammation can make the big toe stiff and difficult to move. This stiffness can limit your ability to perform daily activities like walking or squatting.
Relief Tip: Gentle toe exercises and stretches can help improve mobility. However, consult a healthcare practitioner before starting any new exercise routine.
4. Pain from Certain Shoes
Thin-soled shoes or high heels can aggravate sesamoiditis. The lack of cushioning or the forward tilt caused by heels increases pressure on the sesamoids.
Relief Tip: Opt for shoes with thicker soles or better arch support to reduce strain on the sesamoid bones. If wearing heels is unavoidable, choose those with lower heights and padded insoles.
The Risks of Ignoring Sesamoiditis
When it comes to sesamoiditis, it’s easy to brush off the pain as just a little discomfort that will go away on its own. But ignoring the condition can lead to significant, long-term problems. The sesamoids, though small, are crucial for your foot’s function. If left untreated, sesamoiditis can escalate into more severe issues that affect your ability to move and enjoy daily activities.
Let’s break down the primary risks of ignoring sesamoiditis:
1. Increased Pain
What might begin as a mild ache can turn into persistent, sharp pain. As the inflammation progresses, even everyday activities like walking or climbing stairs can become painful.
Impact on Daily Life: Chronic pain can make simple tasks, such as standing for long periods or even sitting comfortably, a real challenge. If you continue to push through the pain without addressing the root cause, it could drastically affect your quality of life.
Complications: Over time, you might start altering your gait or posture to avoid the pain, which can lead to new problems in your knees, hips, or back. This is one of the reasons why early intervention is essential.
2. Decreased Mobility
Another risk of untreated sesamoiditis is decreased mobility. As inflammation persists, the range of motion in the big toe joint can be limited, making it harder to move or bend your toe.
Impact on Daily Activities: Activities that require toe flexibility, such as squatting, running, or even dancing, can become painful or difficult. Reduced mobility can also make it harder to balance, which could increase the risk of falls.
Complications: Over time, stiffness in the big toe joint may lead to further weakening of the surrounding muscles, which will make it even harder to move the toe and maintain normal foot function.
3. Stress Fractures
If you continue to place pressure on the sesamoids without giving them time to heal, small cracks or stress fractures can develop. These fractures are not only painful but also take a longer time to heal.
Symptoms: You’ll notice that the pain intensifies, especially when you put weight on the foot. Every step may feel like a painful throb, and even the lightest pressure can cause discomfort.
Complications: Stress fractures often require immobilisation and extended rest. In some cases, patients may need to wear a boot or brace to limit movement and allow the fractures to heal. The longer you delay treatment, the more difficult it will be to return to normal activities.
4. Stiffness Leading to Arthritis
Chronic inflammation can contribute to the development of osteoarthritis in the big toe joint. If sesamoiditis is left untreated, the joint becomes stiffer and may eventually lose its range of motion.
Symptoms: The pain from arthritis typically worsens over time, and you may experience swelling, stiffness, and difficulty moving the big toe.
Complications: In the long run, untreated arthritis could deform the joint, leading to chronic pain and severe difficulty with walking. This could also impact your ability to wear certain shoes comfortably.
5. Painful Lesions
As the inflammation continues to put pressure on the area, painful lesions or calluses can form beneath the ball of the foot. These lesions can make every step feel like you’re walking on a pebble.
Impact: Walking becomes not only painful but also frustrating. Over time, the skin can thicken or even ulcerate, especially in individuals with compromised circulation or conditions like diabetes.
Complications: If left untreated, lesions may require medical intervention to prevent infection or further complications. Regular foot care is essential, especially for those with existing foot or circulation issues.
Treatment Options for Sesamoiditis
Now that we understand the risks of ignoring sesamoiditis, let’s look at the treatment options. Early intervention is key, and luckily, there are several effective treatments available to help you get back on your feet, pain-free.
1. Rest and Ice
Taking a break from activities that aggravate the condition is crucial for healing. Ice therapy is a great way to reduce swelling and alleviate pain. Applying an ice pack to the affected area for 15-20 minutes several times a day can work wonders.
2. Orthotic Devices
For many patients, custom orthotics are a game-changer. These insoles redistribute pressure away from the sesamoid bones and provide added support to the foot. This is especially helpful for those with structural issues, like high arches or flat feet.
Local Insight: I’ve seen firsthand how custom orthotics can improve comfort and prevent further inflammation. If you’re dealing with sesamoiditis, it’s worth exploring the benefits of these personalised devices.
3. Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can help reduce both the pain and inflammation associated with sesamoiditis. However, it’s important to use them under the guidance of a healthcare provider, especially if you’re using them frequently.
4. Physical Therapy
Once the acute inflammation is under control, physical therapy can help strengthen the muscles around the sesamoids. This will provide better support and reduce the likelihood of recurrence.
Relief Tip: I often recommend specific exercises to patients that target the foot and lower leg muscles, promoting better function and reducing strain on the sesamoids.
5. Surgery
In severe cases where conservative treatments don’t work, surgery may be necessary. This is usually a last resort, but it’s important to discuss all options with your podiatrist if the condition continues to worsen.
Note: Surgery is typically reserved for cases with chronic, non-responsive pain or where there are fractures that won’t heal with rest.
Sesamoiditis might not be as well-known as other foot conditions, but it’s not something to be ignored. If you’re experiencing symptoms or suspect you may be at risk, early intervention is crucial. At Well Heeled Podiatry, we’re dedicated to helping you recover and get back to your active lifestyle.
Ignoring sesamoiditis may seem like a small decision, but the consequences can be far-reaching. Pain, decreased mobility, stress fractures, arthritis, and lesions can all stem from untreated sesamoiditis. The sooner you address the issue, the better the chances of preventing long-term damage.
Frequently Asked Questions
What Is Sesamoiditis?
Sesamoiditis is the inflammation of the sesamoid bones, two small bones located under the big toe joint. These bones are embedded in tendons and help absorb pressure and friction when you walk. The condition typically causes pain and swelling in the ball of the foot, especially beneath the big toe, and is often caused by repetitive stress or trauma to the area.
What Causes Sesamoiditis?
Sesamoiditis is commonly caused by repetitive pressure or overuse of the foot, particularly in activities that involve jumping, running, or pushing off with the big toe, like ballet, basketball, or running. Wearing high heels or tight shoes that put excess pressure on the forefoot can also contribute. Other risk factors include foot deformities, like high arches or bunions, that place extra strain on the sesamoid bones.
What Are The Symptoms Of Sesamoiditis?
The main symptom of sesamoiditis is pain in the ball of the foot, directly beneath the big toe joint. The pain often worsens during activities that put pressure on the foot, such as walking, running, or standing for long periods. Swelling, bruising, and tenderness in the affected area are also common, and in some cases, a clicking or popping sensation can be felt when moving the big toe.
How Is Sesamoiditis Treated?
Treatment for sesamoiditis focuses on reducing inflammation and relieving pain. Rest and avoiding activities that aggravate the foot are essential. Ice therapy can help reduce swelling, and over-the-counter anti-inflammatory medications like ibuprofen may be used for pain relief. Wearing proper footwear with cushioning and arch support, or using orthotic insoles, can reduce pressure on the sesamoid bones. In more severe cases, a podiatrist may recommend physical therapy or, in rare instances, surgery if conservative treatments fail.
Why Is It Important To Treat Sesamoiditis Early?
Early treatment of sesamoiditis is crucial to prevent the condition from worsening and potentially leading to chronic pain or more serious complications, such as fractures of the sesamoid bones. If left untreated, the inflammation can cause long-term damage to the bones and tendons, which may require more intensive treatments, including surgery. Managing symptoms early on with proper care can ensure a quicker recovery and reduce the risk of recurrence.
