Sesamoiditis: Causes, Symptoms, and Treatment

What Is Sesamoiditis?

Sesamoiditis refers to inflammation of the sesamoid bones, which are small, pea-shaped bones embedded within tendons. These bones act as pulleys, providing a smooth surface for tendons to glide and improving the mechanical efficiency of the foot.

The two sesamoid bones beneath the big toe joint endure significant stress during walking, running, and jumping. Inflammation of these bones and their associated tendons can lead to pain and discomfort, commonly known as sesamoiditis.

Causes of Sesamoiditis

Overuse

• Repetitive high-impact activities like running, dancing, or basketball.

• Prolonged periods of walking or standing, especially in unsupportive footwear.

Biomechanical Factors

• High arches (pes cavus), which increase pressure on the ball of the foot.

• Abnormal foot mechanics, leading to uneven weight distribution.

External Factors

• Wearing high heels or shoes with minimal cushioning.

• Sudden increases in physical activity levels.

Trauma

• Direct impact or injury to the ball of the foot.

Symptoms of Sesamoiditis

• Big Toe Pain: Localized pain beneath the big toe, often worsening with activity.

• Swelling and Inflammation: Swelling around the ball of the foot.

• Difficulty Bending the Toe: Pain may increase when bending or pushing off the big toe.

• Tenderness: Sensitivity to touch or pressure beneath the big toe joint.

Diagnosis of Sesamoiditis

Clinical Examination

• Palpation to identify localized tenderness over the sesamoid bones.

• Evaluation of gait and weight distribution to pinpoint biomechanical contributors.

Imaging

• X-rays: Used to rule out fractures or arthritis in the sesamoid bones.

• MRI or Ultrasound: May be recommended to detect inflammation, tendon issues, or soft tissue damage.

Treatment for Sesamoiditis

Non-Surgical Management

1. Activity Modification

   • Rest and reduce weight-bearing activities.

   • Temporary use of crutches or a walking boot to alleviate stress on the sesamoids.

2. Physiotherapy

   • Strengthening Exercises: Focused on foot and lower leg muscles to improve stability.

   • Stretching Routines: Targeting the calf and foot to reduce strain on the sesamoids.

   • Manual Therapy: Techniques to improve joint mobility and reduce pain.

3. Footwear and Orthotics

   • Switching to cushioned, supportive footwear with low heels.

   • Custom orthotics or metatarsal pads to offload pressure from the sesamoid area.

4. Pain Management

   • Use of ice packs to reduce swelling and inflammation.

   • Non-steroidal anti-inflammatory drugs (NSAIDs) under medical supervision.

Surgical Management

Surgery is rarely required but may be considered for:

• Persistent pain that does not respond to conservative treatments.

• Chronic issues with sesamoid fractures or arthritis.

Recovery Timeline

• Initial Phase: 4–6 weeks of reduced activity to allow inflammation to subside.

• Rehabilitation Phase: Gradual reintroduction of weight-bearing and strengthening exercises.

• Full Recovery: Typically occurs within 6–12 weeks but varies depending on severity and adherence to treatment.

Preventing Sesamoiditis

• Wear supportive shoes with adequate cushioning, especially during high-impact activities.

• Avoid sudden increases in physical activity intensity.

• Strengthen foot and lower leg muscles to improve stability and shock absorption.

• Use orthotics if you have high arches or abnormal foot mechanics.

At Palms Physiotherapy & Allied Health, we’re committed to providing individualized care for sesamoiditis and other foot conditions. Reach out to us for expert diagnosis, tailored treatment plans, and ongoing support.