Sesamoiditis – Pictures, Symptoms, Treatment, Surgery


What is Sesamoiditis?

Sesamoiditis is the most widespread disorder that affects the forefoot.  It is most often found in the younger population of those who are physically active and regularly engage in sports. It is the inflammation of the sesamoid bones and the tissues surrounding them. It usually affects the sesamoid bones found under the toe.

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The Sesamoid Bones on the Feet

Sesamoiditis is a type of tendinitis. Dancers and athletes are more prone to suffer from this disorder since they put much more weight on the forefoot than most people. Like most inflammatory disorders, sesamoiditis also causes severe pain. In this case, the pain is usually felt precisely underneath the first metatarsal joint of the toe. The pain frequently becomes worse as time pass by. This unique symptom helps in the diagnosis of sesamoiditis by distinguishing it from related disorders that involve the foot.

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Sesamoiditis

Sesamoiditis Causes

Sesamoiditis can develop in many ways. If the tissues surrounding the sesamoid bones become swollen, it is then called sesamoiditis even if the sesamoid bones are not directly the ones inflamed. Sesamoiditis is commonly caused by performing similar actions that involve the toe over and over again.

The following are the most common causes of sesamoiditis:

Injury

  1. Direct injury to the sesamoid bones, by hurting your foot or stepping on a rock while walking or running barefoot.

  2. Trauma caused by repetitive and excessive movements involving the toe. This type of injury develops over a period of time. This includes:

    • Running

    • Jumping and falling/landing directly on your heel.

    • Squatting for several minutes to hours.

    • Dancing with no shoes or using shoes with very thin soles.

    • Walking and standing for longer hours while wearing high hell shoes.

Changes that occur with age

  1. Osteoporosis develops when bones become weak due to loss of calcium deposits inside the bone. This creates pain and inflammation of the sesamoid bones and their surrounding tissues.

  2. Osteoarthritis is another disorder that precipitates sesamoiditis. Osteoarthritis initiates the appearance of bone spurs on sesamoid bones.

Heredity

  1. Enlarged sesamoid bones are required to bear unusual amounts of the body’s weight every time one walks or moves forward. Sooner or later due to too much weight and pressure put upon them, their condition starts to decline and weaken until they become inflamed and intensely painful.

  2. Feet with high arches are also commonly more stiff than normal and will not permit the high arch to make contact with the ground when stepping down.

  3. Pronated foot forces one to walk on the inner aspect of the foot rather than on the arch.

  4. A plantar-flexed first metatarsal is another triggering factor of sesamoiditis. This happens when the first metatarsal head is skewed down in the forefoot, instead of lying straight.

Sesamoiditis Symptoms

Sesamoiditis is generally characterized from different painful conditions of the foot by its slow onset of symptoms under the first metatarsal head. The usual symptoms are as follows:

Acute Stage

  • The sesamoids are sore and sensitive whenever direct pressure is put on them.

  • Slight pain is felt while walking barefoot or if wearing thin soled shoes. Pain is more intense when running or jumping.

  • Pain diminishes with rest.

  • Slight swelling at the rear of the sesamoids normally diminished with rest and if foot is raised.

Chronic Stage

  • Relentless pain under the sesamoids.

  • Increased swelling that does not diminish with rest and elevation of foot.

  • Stiffness of the great toe due to swollen 1st metatarso-phalangeal joint.

Sesamoiditis Diagnosis

Bone scanning is the most reliable way of getting an accurate picture and diagnosis. It determines the seriousness of the condition since sesamoid bones are too small to be seen on x-rays. X-ray of the foot is often requested to compare structures of the foot.

Sesamoiditis Treatment

Treatment of sesamoiditis is possible even in the comforts of your own home. Here are the suggested treatments for sesamoiditis:

  1. Resting the foot is important since it will prevent it from bearing too much weight.

  2. Shoes with the following features can help protect and prevent the sesamoids from further injury:

    • Shoes with a well-padded insole. Insoles will provide cushion to the sesamoids every time you take a step.


    • Shoes with a wide and deep toebox to keep the sesamoids from squeezing side-to-side.

    • Use a flat shoe instead of high heeled one. A flat shoe will decrease the pressure and weight that the sesamoids endure when running or walking.

    • Shoes with proper length will also help in the reduction of sesamoid pain.

    • Use of soft gel pads will cushion the foot and decrease the amount of pressure on the foot.

  3. Soaking the foot in warm water will also soother the swollen and painful sesamoids.

  4. Massaging the foot gently with a topical pain reliever may also provide comfort and relief.

  5. Taping the toe slightly downwards (plantar flexion) will let it remain bent to lessen pain and pressure.

  6. Compression will also decrease the degree of swelling.

  7. Orthotic insoles are also used to fix walking gait, bio-mechanically changing the stride to guarantee that the bones and muscles are perfectly aligned and providing cushion to the foot.

  8. Podiatrists also recommend several exercises to regain foot strength and to strengthen them even more. Here are some recommended exercises:

    • Pullback or the flexion of foot towards the body.

    • Stretching exercise that needs a Thera-band or a strong elastic band.

    • Calf stretches to loosen muscles.

    • Hamstring stretches.

    • Eccentric loading: this is the main exercise that helps improve the strength of the muscles around the foot.

  9. Doctors may also prescribe a shot of steroid medication to help reduce the swelling.

  10. If needed, they will also require you to wear a removable short leg fracture brace for 4-6 weeks.

Surgery for Sesamoiditis

In cases where sesamoiditis symptoms have already settled, but the pain is still there, surgery is recommended. In other cases, if the sesamoids are fractured and does not heal correctly, removal of the sesamoids might be necessary.  If surgery is considered, it should be deliberated and given much thought since it will affect the performance of the toe permanently. Enlarged sesamoids can also be reduced via surgery to relieve discomfort and it also avoids the necessity to remove the sesamoids completely.

Sesamoiditis Complications

Even if all that can be done has been done, at home comfort or surgeries, to diminish complications, they may still occur. If sesamoiditis is left untreated, it can cause great discomfort and will eventually prevent one from having a normal life. Weakness and deformity of the toe is also one of the complications of sesamoiditis. These complications may progress and one might not be able to ambulate properly as before. Even after surgery, fracture of the remaining sesamoids may also appear.

Sesamoiditis Pictures

 

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Sesamoiditis Showing as a Hematoma on the Balls of the Feet

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Orthotics to Prevent the Sesamoid Bones from Touching the Footwear

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Comments

  1. Unfortunately, those people suffering from chronic back pain and
    depression may not get the proper diagnosis. This upper back region generally experiences small movement.
    Chronic back pain is actually a type of pain which continues more than twelve weeks and is generally connected with degenerative forms of the spine.

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