What is Sesamoiditis?
Sesamoiditis is an inflammation of the bones in the foot called the sesamoid bones and the tissues that surrounds it. Sesamoid bones are found below the large toe with an approximate size of a jelly bean. These bones are set in within a tendon and operate as protection and support to the adjacent tendon and improve its mechanical functions. Sesamoid bones are located in the knees, hands and foot. Sesamoiditis occurs mainly in people who are into running or dancing since it involves pushing off the toes. The sesamoid bones’ main function is to act like a pulley to increase the force of the tendons that controls the toe. And because of frequent pushing off of the toe, it becomes irritated resulting to sesamoiditis.
Characteristics of Sesamoiditis
- The swelling and inflammatory process usually occurs at the foot at the distal portion of the first metatarsal bone (big toe). It causes inflammation, pain, tenderness and swelling in the area.
- Periostitis or fresh bone growth can also take place along with sesamoiditis as manifested by an outward protuberance of the big toe
Once the sesamoids are inflamed and irritated, it is usually difficult to remove it because walking will always give strain on it.
Sesamoiditis can occur to any person at any age. Most of the time among younger individuals, this is due to trauma on the foot and stress.
Sesamoiditis often results from excessive stress on the tendons and bones as a result of sudden flexion of the toes, wearing high-heeled footwear, and damage to the sesamoid bone. Excessive activity may also predispose a person for the occurrence of swelling in the sesamoid bones. Amongst women, those who wear high heels have greater chance of having sesamoiditis. This is because of the increased pressure on the forefoot. Athletes and dancers may also develop this problem over time.
A bony foot usually puts added injury to the sesamoids because there are no enough subcutaneous layers in the soles of the feet to cushion the sesamoid bones.
In older men and women, sesamoiditis occurs because of old age and the formation of added bones which lead to bone spur. The bone fragments can cause inflammation of the tissues that surrounds the area. Osteoarthritis is also another cause for sesamoiditis. Because of old age, the bones become weak which results to reduced ability in coping with the force exerted when walking.
Other causes include bone abnormalities wherein the sesamoid bones are larger than the jelly beans. The larger the bone, the greater force is to be exerted when walking which will increase the likelihood of injuries.
High Foot Arches
Also people with high arches have the tendency to have strained foot and overpronating can also result to sesamoiditis.
- Pain. Pain is the most universal symptom of sesamoiditis. This occurs mostly when walking, but even if simple weight bearing exercise can also cause pain. The pain is brought about by the tibial sesamoiditis since it is directly located at the base of the toe.
Tibial sesamoiditis is one of the common sesamoiditis wherein the medial or tibial sesamoid is affected. This is located at the inner edge of the foot and lies directly beneath the 1st metatarsal head.
- Gradual Onset. Sesamoiditis occurs gradually. The pain associated with sesamoiditis begins as mild and progresses to become severe.
- Swelling. Swelling is often seen in sesamoiditis. Bruising and redness may also be observed, but are more uncommon.
- Tenderness. Other symptoms include tenderness in the surrounding area and it worsens when there is pressure applied like walking or when the foot pronates.
Sesamoiditis is easy to diagnose using the following procedures:
Usually, with x-ray alone, it can confirm the problem. However, the sesamoids from time to time can be fractured and these do not usually become visibly clear on x-ray. In this case, a bone scan may be done to determine it.
A bone scan may also be ordered by doctors to correctly diagnose if it is a bipartite sesamoid or not.
Sesamoiditis when it is not worse can be treated with home remedies to stop the pain and rest the foot. When these home remedies do not relieve the symptoms, it is always best to consult a physician.
Resting the feet is very important and then gradual activities may be added to avoid fatigue and pressure on the foot. Rest is the chief management to allow the foot to heal and reduce pressure on the area.
With the use or tape or athletic straps, sesamoiditis taping is done in order to immobilize the joint in the foot. This then allows healing of the sesamoid bone as well as the tissues and muscles surrounding the area. While the toe is being taped, it is important to avoid doing activities like running, dancing or even walking.
Apart from taping the foot, it is also best to ice the sole of the feet. But it is not suggested putting ice directly since it will cause frostbite. Instead, use ice packs or wrap the ice with towel and apply it on the foot.
If activities cannot be stopped such as walking, it is best to uses soft-soled and low-heeled shoe to decrease the pressure. Cushioning pads may be added too in order to feel comfortable.
There are certain flexibility exercises that will help in stretching the plantar fascia, which is located below the arch of the foot. Sesamoiditis exercises can be done while on the process of recovery from the injury. While standing up, face the wall and then put a ball on top of the foot and the toes will be stretched upward. It is important to keep the heel on the floor. Then, stretch the knees facing the wall so that the arch of the foot will be stretched. Hold this position for 10 to 30 seconds depending on the person and the exercise can be repeated 3 times. This will help stretch the muscles of the foot and strengthen it in the process especially for those who are into running or dancing.
On the other hand, there are other forms of exercise alternatives such as swimming or biking. In that case, there is no need to pronate the foot which can result to sesamoiditis. Avoid more feet pounding exercises which will worsen the tenderness in the foot.
If the Sesamoiditis is very worse, then it is time to consult the doctor. Especially with fractured bones, there is a need to perform operation in order to treat the problem and walk without pain. Sometimes if the fracture is worse, there is a need to remove the sesamoid bones, but it needs further assessment and planning since it can affect the toe and its function. A few surgical discomforts may be felt after Surgery like pain and swelling, but it will be better as days pass by. According to surgeons, there will be pain medications to be taken and using of crutches is useful to aid in mobilization. Full recovery may take months. But if there is no surgical incision, patients are expected to be walking, but with limited movements for 2-3 weeks. And for athletes who are into running, they need to wait about 2-3 more months to use their injured foot, but with limited range of motion.
Anti-inflammatory drugs are used to relieve pain and swelling. Common drugs administered are ibuprofen, aspirin and naproxen.
Sesamoiditis is a mild foot condition that is highly preventable. Prevention of sesamoiditis is simple such as employing the following measures:
- Avoid using high-heeled shoes always. Use flat shoes from time to time.
- Apply shoe cushions.
- Engage in foot exercises after a day’s work.
- Rest the foot at night by elevating it in a pillow for 15 minutes to improve circulation to the bony prominences.