Sesamoids are small bones found throughout the body. Sesamoid bones provide attachments for tendons, and act as fulcrums or pulleys for muscles. Two common sesamoids that can become irritated are on the bottom of the big toe. They can become irritated or fractured, producing pain on the bottom of the big toe. Pain localized to a specific location is the most common symptom of sesamoiditis.
The flexor hallucis longus muscle uses the sesamoids as anchors during running or pulling with the big toe. The sesamoid bones are attachment sites for the flexor hallucis brevis, adductor hallucis, and abductor hallucis muscles.
Common Causes of Sesamoiditis
Sesamoiditis commonly occurs from direct trauma or repetitive use. Running, jumping from a height, ballet, and poorly fitting shoes can cause the condition. Increased pounding activities on hard surfaces are the most common causes.
Home treatments for Sesamoiditis
Rest and ice for several weeks will allow the irritation to heal. Use of doughnut-shaped padding under the big toe will help to relieve direct pressure on the sesamoids. Less flexible shoes, playing and working on softer surfaces will increase the speed of healing.
Treating Sesamoiditis in the Office
If the pain continues, your provider will evaluate you for the possibility of fracture or arthritis, which can be determined by a simple X-Ray. Because of the attachment of the flexor hallucis brevis, sesamoid fractures have a higher tendency for displacement of the fracture, leading to a high rate of delayed or nonunion healing.
In office treatments will focus on decreasing the inflammation around the sesamoid. Specific taping to provide stability and relief to the area is common. Your provider may address the foot and lower leg muscles if they contributed to causing sesamoidits.
Presence of hallux vargus (big toe pointing to the side) or bunions can complicate treatment. Orthotics may be helpful in some cases. Difficult cases may require cortisone injections or surgery.
Sesamoiditis is a frustrating injury that takes time to heal. Proper rest and treatment will provide the greatest benefit and shortest healing time.