What is it?

Sesamoids are small, seed-shaped bones that are located underneath the base of the first (AKA big) toe. They serve to protect and cushion the bottom of the first toe. Sesamoiditis is the painful inflammation of a sesamoid bone and its surrounding tendons and tissue structures due to repetitive stress. It is seen in a variety of athletes, including runners, dancers, basketball players and tennis players.

Symptoms/Risks

Pain is typically located at the bottom of the first toe, which is worsened with activities such as jumping or dancing when the toe “pushes off” the ground. Initially the pain improves with rest, but it can worsen with walking or standing if not addressed early. Swelling or bruising can sometimes be noticed as well.

Sports Medicine Evaluation & Treatment

A sports medicine physician will review symptoms, ask about any relevant past medical history, press along the ball of the foot and elevate the great toe to reproduce the pain. Initial evaluation may include an x-ray, specifically focusing on the sesamoid. If there is concern for a fracture, an MRI can be obtained to look at the sesamoid and surrounding structures.

Treatment of sesamoiditis will depend on several factors, including the sport in which the athlete is participating, timing of the injury, and degree of pain the athlete may be experiencing.

The initial treatment involves rest, immobilization, ice, and elevation. Patients will be advised to decrease the amount of weight they place on their affected foot and refrain from activities responsible for the pain, such as running or dancing. Anti-inflammatory medications, such as ibuprofen, may offer some pain relief. Steroid injection in the soft tissues in between or around the bones may also be considered to help relieve the pain. If a stress fracture of the sesamoid is found, staying off the foot (non-weight bearing, usually by using crutches or a scooter) in a protective boot or cast for about 6 weeks is needed until the patient is no longer tender over the sesamoid. For severe cases that fail therapy, surgery can be performed to remove the damaged or fragmented sesamoid bone.

In order to prevent this injury from recurring, patients may have gait analysis or try orthotics to decrease the weight placed on the great toe.

Injury Prevention

Numerous factors contribute to the development of sesamoiditis, and most of them are not preventable. People with high foot arches, flat feet or those who run on the ball of their foot may be more prone to sesamoiditis. Wearing cushioned and protective shoes can help distribute pressure across your foot. If this is a recurrent problem, a gait analysis can assess if the foot is putting too much pressure.

Return to Play

For mild cases of sesamoiditis, an athlete can participate in sports using ice, anti-inflammatories and an orthotic to deflect pressure away from the painful area. If symptoms are persistent and affect the athlete’s ability to compete, some non-weight bearing time may be necessary, followed by the use of a hard-soled shoe until symptoms have resolved. If there is a stress fracture of the sesamoid, up to six weeks of non-weight bearing in a cast or protective boot is needed for proper healing, followed by a gradual return to activities over several weeks.

AMSSM Member Authors
Stephen Carek, MD; Charlie Michaudet, MD and Guy Nicolette, MD

References
Landorf K, Simons S, Jordan C, Rathleff M. Foot Pain. In: Brukner and Khan’s Clinical Sports Medicine. 5th Ed. North Ryde NSW: McGraw-Hill Education; 2017: 968-969.
Atiya S, Quah C, Pillai A. Sesamoiditis of the metatarsophalangeal joint. OA Orthopaedics 2013 Sep 09;1(2):19.