Sesamoiditis

What are the sesamoid bones?

A sesamoid bone is a bone that lies within a tendon. The big example is the patella or kneecap bone lying mobile in the front of the knee within the thigh muscle tendon. In the foot the “SESAMOIDS’’ refer to 2 tiny bones under the ball of your big toe. Each one is about 1x1.5cm in size and helps the big toe joint moving from a straight position to a bent or flexed position.

What causes a problem with the sesamoids?

Different problems can arise at the sesamoid bones:

• Athletes can acutely injure around the sesamoids or even fracture the sesamoids. This is often referred to as a turf toe injury and the toe bends backwards quite a lot.
• Arthritis or wear and tear around the big toe can cause arthritis around the sesamoid bones and cause pain on walking and activity.
• The bones can become inflamed even without much arthritis around the joint. This is referred to as “SESAMOIDITIS”.

What are the symptoms?

• An acute injury causes severe pain, swelling and bruising around the big toe that can indicate a “turf toe” injury. Patients find it difficult to weight bear and roll forwards on their foot when walking.
• Dull chronic pain especially if it comes and goes under the ball of the big toe, or changes with certain shoes or activties can be indicative of sesamoiditis. If the pain is more persistent and even at night, the toe may have developed arthritis around the sesamoid bones.

How are the symptoms investigated to reach a diagnosis?

The clinical story can indicate whether an acute injury is likely or a more persistent chronic problem exists. An X-Ray can determine whether the bone is positioned correctly or even fractured. Special X-Ray views can be taken to look accurately at the sesamoid bones under the big toe. Other special tests can be helpful including an MRI scan or a CT scan, but your surgeon will advise on this as required.

Can the problem get worse?

If the symptoms are associated with an acute injury, rapid surgical assessment is advised to ensure return to full function is assured. In the presence of a chronic, grumbling pain in the toe it is likely that it will continue to persist without surgical assessment, where a variety of treatments may be applicable.

How do you treat sesamoid pain?

In the presence of an acute injury please refer to turf toe injuries

For more chronic patterns of symptoms:

• Off-load the toe
  The foot can be off-loaded with a boot or special insole to allow any inflammation to settle. Long-term insoles can be used for maintenance of treatment
  
  
• Activity modification
  Avoidance of exacerbating activity, at least in the short term is advised
  
  
• Anti-inflammatory medications, as can be used in any form of arthritis can alleviate symptoms
  
  
• Physiotherapy
  Stretches or local ultrasound therapy can benefit some patients
  
  
• Surgery

Surgical intervention can follow other non-invasive therapies if unsuccessful. The sesamoid bones can be removed if troublesome however the surgeon must ensure correct reattachment of important tendons that were attached to the sesamoids to ensure good toe strength. If the sesamoids have been fractured then fixation with a screw can be done. Return to a good level of activity should be possible following surgery.

Deciding whether sesamoid surgery is necessary

Many patients are simply seeking advice on managing a problem. If non-operative measures have been unsuccessful and your quality of life is affected then surgery can always be discussed with your surgeon who will inform you of the potential outcomes from the surgical intervention planned.