Sesamoiditis: Causes and Treatments

You know what happens when the ball bearings go bad in your car wheels. You hear a grinding sound, your steering wheel becomes shaky, and you could even lose the tire at high speeds. It’s not exactly the same, but you have two small bones under each of your big toes that can give you trouble, too. That spring when you push off for a step is partly due to two sesamoid bones, which act like pulleys to increase the leverage of the flexor tendons underneath. When they get worn out, the growl and screech you hear could be your own—caused by pain in the ball of the foot.

Causes of Sesamoiditis

The two round bones are located under the first metatarsal head—the front end of your foot bone that connects to your big toe. Any irritation of the bones or their surrounding tissue can cause pain, swelling, and inflammation. Irritation can happen for a variety of reasons. For instance, a fracture of the sesamoids can occur with a hard impact to the ball of the foot.

Repeated trauma can also injure the bones. This can come from playing sports with lots of directions changes (tennis, racquetball, soccer), squatting on the ball of your foot (catching in baseball, gardening, standing on ladders), or landing on your forefoot when running or dancing. Even simple things like wearing high heels, stepping funny on a stone or curb, or bending the toe back too far during activity could damage the bones or the tendons around them.

Sesamoiditis and Other Related Conditions

Osteoporosis can contribute to inflammation in the bones or surrounding tissues by weakening them so they can’t withstand damage from daily activity. A certain deterioration happens normally with aging, too, and osteoarthritis can cause little spurs to form on the bones and be a trigger for pain and inflammation.

The foot structure you inherit can also make you more vulnerable. Sesamoids that are larger than normal can cause pain from day one of walking. Flat feet or any other structure that leads to overpronation (feet rolling too far inward during your steps) can put you at risk, too. Too much pressure on the small bones can lead to micro fractures or irritation on the tendons and soft tissue.

How Sesamoiditis Is Treated

Once you have the condition, it can be quite hard to cure, because it is aggravated with every step you take. The problem often appears after you have increased your activity—say, adding hills to your runs, or speed sprints to your workouts.

When you come in to find out why your toe or forefoot hurts, we will examine the foot and try different movements of the toes to see what causes the pain. We will likely take x-rays, too, to see if there is a fracture. Once we’ve determined that you are indeed suffering from this condition, we can start treating it.

We will begin with conservative treatments like rest, icing, and orthotic devices to offload pressure from the big toe joint. This will give the sesamoids and tendons time to heal. If the pain is very bad, we may give you a laser treatment to lower pain and swelling and increase cell healing. During this time, you should always wear supportive shoes—not high heels, flats, slippers, or flip flops.

Further Options for Pain under Your Big Toe

If you still suffer inflammation and pain after trying these remedies, we can arrange for surgical treatment. This usually means simply removing the bones through the side of the foot. The procedure lasts about a half hour, but full recovery will usually take about 4 to 6 weeks.

If you are suffering from pain in the ball of the foot, come in to Ottawa Foot Clinic and let our team evaluate what is causing it. A simple call to (613) 595-9700 will put you in touch with our office in Canada’s Capital district, so you can schedule your appointment, or you can do so using our online contact form. Don’t let the problem get worse: act today to find relief from your foot pain.

Causes of Sesamoiditis