The Center for Podiatric Care and Sports Medicine

Patients Ask: How to Treat Sesamoiditis?

Posted by on Wednesday, July 11th, 2018

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At The Center for Podiatric Care and Sports Medicine, we know exactly how to treat sesamoiditis. Unlike most bones in the body, the sesamoid bones connect to tendons or are embedded in muscle, rather than connecting to joints. They act as pulleys by providing a smooth surface for the tendons to glide over and disperse muscle force. The kneecap is the largest sesamoid in the body, but here in our NYC office we treat the two sesamoids located underneath the big toe.

How to Treat Sesamoiditis
[Sesamoid bone fractures are rarely the cause of pain. Sesamoid tendon inflammation (sesamoiditis) is more commonly the culprit for ball-of-foot pain. Image Source: Wikimedia.org]

One sits on the outer side of the foot, and the other is in the middle of the foot. These small sesamoids elevate the big toe bones and assist in weight bearing. The sesamoids are capable of fracturing like any other bone but are more commonly painful due to a condition known as sesamoiditis—the irritation and inflammation of the surrounding tendons, which compress the bones. These injuries are most commonly seen in ballet dancers, runners, and baseball catchers who spend a lot of time on their toes, but the injury can happen to anyone with certain foot anatomy characteristics. Here we address some of the most frequently asked questions about sesamoiditis.

What are the symptoms of sesamoiditis?

Patients with sesamoiditis may experience:

  • ball-of-the-foot pain under the big toe—often gradually developing as opposed to a fracture’s sudden onset of pain.
  • swelling and bruising—which are common, but not always present.
  • difficulty and pain when bending and straightening the big toe.

How is sesamoiditis diagnosed?

A physical examination is standard, where a podiatrist checks for sesamoid tenderness by manipulating the bone slightly or asking the patient to bend or straighten the toe. Bending the big toe upward typically intensifies the pain. An X-ray is often ordered to look for bone fractures, which carry many of the same symptoms. If the X-rays look normal, a bone scan may be requested as well. MRIs can confirm or deny inflammation inside the bone and damage to surrounding soft tissues.

Is cortisone bad for sesamoiditis?

Sometimes short-term cortisone (three-day betamethasone or dexamethasone) is offered in cases of severe acute pain. Long-acting cortisone (nine-month Kenalog or Celestone) should never be administered into injured tendons, as they are associated with further weakening and rupture. When there is bone or cartilage damage, long-acting cortisone can make matters worse.

Do orthotics help with sesamoiditis?

A podiatrist can custom-fit a specialized, full-length orthotic shoe insert that will center the patient’s weight and remove pressure off the painful sesamoid, shifting some of the weight bearing to the arch and other metatarsal heads instead. Extra padding can be placed under the area to “float” the sesamoids. Often, people with sesamoiditis have natural foot anomalies like pronation, high arches, and weak ankles that can be adjusted with orthotics, rather than surgery.

An over-the-counter prescription could do more harm than good, as it is not customized to ensure weight distribution away from the injured region. While you can use crutches or go into a walking boot to offload pressure, most patients prefer the orthotic if they have the choice. In severe cases, there may be no choice but to go with further immobilizing measures for 6-8 weeks.

When can I walk barefoot with sesamoiditis?

Swelling and discomfort prevent many patients from barefoot walking. The walking boots and orthotics aren’t designed to combat swelling. Rather, they are effective at offloading pressure—but only while wearing the device. In some cases, velcro straps can actually trap swelling in the foot by slightly restricting blood supply back to the heart.

What shoes are recommended for sesamoiditis?

Patients with sesamoiditis are advised to look for anatomically shaped, wide toe-boxes, which allow the toes to splay within the shoe. A zero heel-drop will keep the heels and balls of the feet flat, rather than shifting pressure onto the forefoot. Shoes with no toe spring helps prevent the natural fat pad from atrophy. Hoka is a commonly recommended brand for a variety of foot issues, sesamoiditis included. Altra is another good sesamoiditis shoe brand, designed for runners.

How much activity can I do and how to treat sesamoiditis pain?

Many patients will be able to work up to 30 minutes of walking in the right shoe. Non-impact elliptical, stationary bike classes or aquatics are ideal activities easing back into exercise. Patients should not just focus on restrengthening the injured foot, but conditioning their legs and core to bear some of the burden.

Right after activity, it’s wise to ice for 5-10 minutes. If there is swelling, a contrast bath can be helpful. Place your foot in a basin of warm water for one minute, followed by a basin of ice water for one minute, alternating for 20 minutes. Pain-free massage and physical therapy are other therapeutic interventions that offer relief.

Sesamoiditis Treatment in NYC

If you’re in or around the NYC area, contact The Center for Podiatric Care and Sports Medicine for an expert consultation, tailored to your unique situation.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.