No. The bunion (hallux valgus) is a lateral deviation of the big toe with medial bony prominence in the head of the first metatarsal. Sesamoiditis is an inflammation of the sesamoid bones located under that same metatarsal. They can coexist – in fact, hallux valgus is a risk factor for sesamoiditis – but the pain is different: the bunion hurts laterally, sesamoiditis hurts on the sole. Confirming the difference is key because treatment varies substantially.

Clinically, it is difficult to differentiate between them: both hurt when resting and worsen with dorsal flexion. The difference is in the image. Sesamoiditis shows bone edema in MRI without fracture line. Acute fracture shows radiolucent line with irregular borders; stress fracture appears as intense bone edema with or without visible fracture line. A detail: the bipartite sesamoid (anatomical variant with smooth and symmetrical borders) is often mistaken for a fracture. That is why radiography and, when in doubt, MRI are essential.

Sesamoids are small bones, without direct contact with continuous bone tissue and with scarce terminal vascularization. When inflamed or fractured, the limited blood supply delays healing. In addition to the fact that each step places a significant load on the area, healing or resolution of the inflammation requires weeks or even months of actual, not relative, unloading. A small percentage of fractures progress to nonunion and an even smaller percentage to osteonecrosis (Renander’s disease).

In the acute phase, impact sports are contraindicated: each step reactivates inflammation and prolongs the injury. You can maintain cardiovascular work without impact: cycling, elliptical, swimming with equipment or with the first toe well protected and strength training without painful support. The return to running or dancing is planned to be progressive, once the pain disappears in walking and in selective load tests. Forcing earlier usually means repeating the cycle from the beginning.

Sesamoid offloading inserts are the first line of treatment and resolve a considerable majority of cases on their own or in combination with rest and NSAIDs. Several studies put the response at 70-85% at 8-12 weeks (Sims, 2014). Their success depends on three factors: that they are well designed (real unloading of the affected sesamoid, not generic), that they are accompanied by appropriate footwear and that the patient respects sports rest during the acute phase. They are not a universal solution: if they fail, we escalate to infiltration or surgery.

Performed under ultrasound guidance and by experienced professionals, peri-sesamoid infiltrations are safe and painless. We use extended-release corticosteroid or platelet-rich plasma (PRP) depending on the case. We limit the number (rarely more than 2-3 sessions) to avoid tissue atrophy or risk of tendon rupture, and we always combine them with insoles and biomechanical work so that the improvement is sustained and not a temporary patch.

Sesamoidectomy is planned to minimize biomechanical impact. Removing only one sesamoid (medial or lateral, the affected one) is well tolerated in most patients, although a small loss of toe-off strength of the first toe and, in some cases, progressive hallux varus or valgus deformity may occur if the insertions are not respected. We never remove both sesamoids at the same time unless there is a major cause: doing so is associated with significant weakness of the first radius and secondary deformities. The MIS technique preserves the neighboring structures better than open surgery.

After conservative treatment, return to running or dancing usually occurs between 8 and 12 weeks with insoles and progressive work. After infiltration, relief appears at 7-14 days and return to full sport at 4-6 weeks. After MIS sesamoidectomy, we schedule light activity (cycling, swimming) from the 4th-6th week and impact sports between the 10th and 14th week, always with clinical and radiological assessment. Traditional open surgery tends to extend these periods by several weeks.

Yes, especially if the predisposing factors are not corrected: foot biomechanics, footwear, sports technique and training load. Sesamoiditis treated only with NSAIDs or rest, without addressing the cause, often recurs when returning to sport. That is why our protocol always includes gait analysis, personalized maintenance insole, footwear review and sports progression guideline. After a well-indicated sesamoidectomy, recurrence of the original condition is rare, although pain may appear in the opposite sesamoid if the biomechanics are still altered.

To a large extent, yes. The keys: gradual progression of loads (no more than 10% per week), proper shoes and renewed on time, foot strength work, proprioception, weight control and, if you have a cavus foot or pronated forefoot, custom insoles as a preventive measure. In dancers, the technique of rising to pointe and the dosage of classes are decisive. An annual sports podiatry check-up is the most effective way to detect risk factors before they turn into injury.