Sesamoiditis (Ball of Foot Pain)

What is Seasmoiditis? How is it Treated?

Sesamoiditis is inflammation of the sesamoid bones, which are small bones located beneath the big toe joint in the foot. Understanding its diagnosis and treatment options is crucial for effectively managing this condition and alleviating pain and discomfort.

Symptoms

Symptoms of sesamoiditis may include pain, swelling, and tenderness beneath the big toe joint, particularly during weight-bearing activities like walking or running. Pain may be aggravated by bending the big toe or pushing off the ball of the foot. In some cases, there may be difficulty bearing weight on the affected foot or performing activities that require bending the toes. Some patients say they feel like they are standing on a pebble or a marble underneath their big toe.

Diagnosis

Diagnosing sesamoiditis typically involves a physical examination to assess for tenderness and swelling over the sesamoid bones. Imaging studies such as X-rays may be ordered to confirm the presence of inflammation or identify any associated fractures or abnormalities in the sesamoid bones. Additionally, MRI or CT scans may be used to evaluate the extent of soft tissue involvement and assess for any ligament or tendon injuries.

Non-surgical Treatment

Initial treatment for sesamoiditis often involves conservative measures aimed at reducing inflammation and relieving symptoms. This may include rest, ice therapy, and over-the-counter pain medications to alleviate pain and discomfort. Offloading the pressure from the sesamoid bones by wearing cushioning pads or insoles may help reduce irritation and promote healing. Stiff-soled shoes or shoes with a rocker bottom design can also help decrease stress on the sesamoid bones during walking or running. Physical therapy exercises focused on strengthening the muscles of the foot and ankle and improving flexibility may be beneficial in relieving symptoms and preventing recurrence. Gait retraining is key as well, since many patients tend to walk on the pinky-toe side of their foot to offload pressure on the big toe when the sesamoids are inflamed. 

Surgical Treatment

If conservative measures fail to provide relief, surgical intervention may be considered for severe or refractory cases of sesamoiditis. Surgical procedures for sesamoiditis typically involve removing the inflamed or damaged sesamoid bones to alleviate pain and restore function to the foot. This may be performed through minimally invasive techniques, such as sesamoid bone excision, or open surgery, depending on the severity of the condition and the patient's treatment goals. In some cases, additional procedures, such as tendon transfers or joint realignment, may be performed to address underlying biomechanical issues and optimize foot function.

Recovery

Recovery following surgery for sesamoiditis varies depending on the type of procedure performed and the individual's overall health and healing response. Patients may be advised to wear a protective boot or cast for several weeks to allow for proper healing of the surgical site. Physical therapy may be initiated to restore strength, flexibility, and function to the foot and ankle, gradually progressing to weight-bearing activities as tolerated. Full recovery may take several months, and patients may be advised to avoid high-impact activities or excessive weight-bearing on the affected foot during the healing process.

Is there anything I can do to prevent sesamoiditis?

While the exact cause of sesamoiditis is not always clear, certain measures may help reduce the risk of developing this condition or experiencing recurrent symptoms. This includes wearing supportive footwear with adequate cushioning and arch support, avoiding activities that place excessive stress on the forefoot, and maintaining a healthy weight to reduce pressure on the sesamoid bones. Additionally, incorporating regular stretching and strengthening exercises into your routine can help improve foot and ankle flexibility and strength, reducing the risk of injury and inflammation.

After surgical treatment for sesamoiditis, how likely am I to experience symptoms again?

The success rate of surgical treatment for sesamoiditis is generally high, with most patients experiencing significant relief of symptoms and improved foot function. However, there is always a risk of recurrence or persistent symptoms, especially if underlying biomechanical issues are not addressed. Adhering to post-operative instructions, engaging in appropriate rehabilitation exercises, and following a comprehensive preventive care plan can help optimize outcomes and minimize the risk of recurrent symptoms.