Sesamoiditis of the foot
Sesamoid bones, named for their resemblance to a sesame seed, are small bones found in the metatarsal head mainly of the first toe.
These structures can become inflamed when we perform high-impact activities, such as running or jumping, due to repetitive overloading, which can in turn cause pain and edema of the area.
Inflammation of the sesamoid bones, or sesamoiditis, is a condition that runners, jumpers and dancers may experience.
The sesamoids are two small bones located under the head of the first metatarsal of the foot. Its main function is to cushion and distribute the load during the forefoot toe-off phase.
Sesamoiditis is relatively common in dancers and runners.
Occasionally the sesamoid bones can become stress fractured, requiring surgical removal. Likewise, it is common to find the sesamoid bones displaced from their usual place in patients suffering from bunions or hallux valgus and with hyperextension of the first toe.
Symptoms
The main symptom of sesamoiditis is pain at the base of the first toe. It is worsened by walking or running due to repetitive pressure on the sesamoid area. Pain may be accompanied by inflammatory signs such as edema, redness and increased temperature of the area.
Causes
The main causes of sesamoiditis are the following:
Hyperpressure at the base of the first toe that occurs when the foot leaves the ground.. It is more likely to occur in athletes due to the constant impact generated in this area.
When the “plantar pad”, which is like a natural cushioning of our body, is too thin, the metatarsal area receives a greater impact and causes inflammation and pain.
People with cavus feet, exert a greater overload on the metatarsal heads when walking. This can cause metatarsal pain and be associated with sesamoiditis.
When we wear high heels for a long time, our body experiences excessive strain. This can lead to various foot problems, including pes cavus or sesamoid hyperpressure, which causes pain in the toe region and/or around the heels.
Diagnosis of Sesamoiditis
The specialist physician or podiatrist should perform a complete physical examination of the foot with a gait study. In addition, imaging tests with radiography and ultrasound of the foot can be used to confirm the diagnosis and rule out other associated pathologies.
Most of the population has two clearly defined sesamoid bones (one medial and one lateral) on an anteroposterior radiograph of the foot. However, 10-15% present sesamoid bones with two or more fragments, making it difficult to assess a possible fracture. For this reason, X-rays of both feet are essential for a correct diagnosis.
Treatment
The first line treatment consists of relative rest, comfortable footwear and the use of NSAIDs (Ibuprofen, Enantyum, etc. as long as there is no allergy or intolerance). This should always be prescribed by a physician.
When this treatment is insufficient, it will be necessary to perform a gait study for the preparation of special orthopedic insoles for sesamoiditis.
Infiltrations are one treatment option to relieve initial symptoms, but without an orthotic insole to distribute foot pressures, sesamoiditis often recurs.
Finally, percutaneous or minimally invasive surgery is reserved for recurrent cases or those requiring correction of other foot deformities that are causing the sesamoiditis.
When symptoms are mild, treatment can be limited to rest, avoiding repetitive foot impact activities and avoiding the use of high heels.
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