Sesamoiditis




What is Sesamoiditis?

Sesamoiditis is a foot condition that involves pain and inflammation in a specific set of sesamoid bones. These are the bones located underneath the first metatarsal head. In layman's terms, the sesamoid bones are located in the part of the ball of the foot that is just behind the big toe.

What is a Sesamoid Bone?

The normal way for bones to be organized in the human body is for them to connect to one another. These locations are called joints. Some bones, however, do not follow this pattern and form typical joints. In place of being connected to other nearby bones, they are embedded inside muscle tissue or they connect directly to tendons.

sesamoid boneSuch bones are referred to as sesamoid bones. When they become painful and inflamed, making walking or jumping painful, the condition may be sesamoiditis. This word refers to a general painful and / or swollen condition of the sesmoid bones.

However, it is important to remember that a number of painful conditions can affect the front half of the foot, and not all of them as sesamoiditis. A careful review of the symptoms associated with this condition can help patients understand whether it is likely that they have  sesamoiditis, though the importance of a professional diagnosis cannot be understated.

Causes of Sesamoiditis

Many, although by no means all, of the causes of sesamoiditis can be avoided because they are behaviorally based. These kinds of causes include all of the following actions -- patients who wish to avoid sesamoiditis in the future should take care to avoid these behaviors to the maximum extent possible.

Behaviorally-Based Causes

  • Injury to the sesamoid bones, such as may occur when walking or running barefoot.
  • Stepping on rocks, especially when wearing shoes with inadequate soles or while going barefoot.
  • Repetitive stress injuries can also cause gradual damage over time to the sesamoid bones. Also know as micro trauma or an overuse injury, these injuries result from a myriad of causes:
  • wearing high heel shoes for many hours each day (in fact, wearing high heeled shoes is responsible for a wide variety of foot ailments)
  • poor form when running, especially when excess stress is applied to the ball of the foot
  • jumping up and landing on the ball of the foot
  • vigorous dancing, especially in inadequate shoes such as those with thin soles or dancing while barefoot
  • squatting for several hours each day -- this type of posture puts excessive pressure on the balls of the feet.

Non-Behaviorally Based Causes of Sesamoiditis

Not all cases of sesamoiditis result from the patient's own actions, unwitting or otherwise. Some causes are the results of completely separate risk factors for the condition. These include:

  • The natural process of aging, in which body systems become less flexible and less efficient in general.
  • Osteoarthritis. This is associated with aging, of course, but it also has specific implications for the development of sesamoiditis because age-related arthritis can lead to the formation of small spurs of bone on the sesamoid bones themselves. Such spurs stick out awkwardly and can irritate the flexor tendon in which the sesamoids rest. This can lead to not just pain and swelling, but also inflammation in both the sesamoid bone and the tendon encasing it.  
  • Osteoporosis. Another condition heavily associated with aging, osteoporosis is a situation in which the bones become thinner and weaker over time because they are losing calcium -- not even an adequate daily intake of the mineral by means of foot and supplements can ward off the process completely. The condition of osteoporosis can cause the sesamoids to thin out and become weaker. As this progresses, these bones become increasingly unable to handle the pressure that is placed on them whenever a  patient stands, walks, runs, or jumps. Each and every step he or she takes can cause tiny fractures to develop. The inevitable result is the familiar swelling, pain, and inflammation associated with sesamoiditis.
  • Not all causes are related to the aging process. Some relate to the existence of genetic predispositions to the condition of sesamoiditis or actual defects in foot structure that we may have had from birth onwards.
  • Pronation is a tendency for people to walk with a gait that involves the foot rolling outward at the ankle joint. As patients walk this way, they place more stress, weight, and pressure on the inner edge of the foot. This stresses the big toe excessively, along with the sesamoids behind the first metatarsal head. Over time, pronation will lead to irritation of the sesamoids and hence the condition of sesamoiditis.
  • Some people are simply born with larger than average sesamoid bones. Because they are larger, they absorb more weight than is typical when a patient runs, walks, stands, or jumps. Since the sesamoid bones were not designed to bear this extra weight, over time it leads to inflammation and the development of sesamoiditis.
  • High arches can also be a problem. Again, this is an issue of genetics and not something the individual patient can prevent through home care or other means. In the situation of high arches, the foot does not flex properly. Specifically, when the foot is placed down and weight is brought to bear on it, the arch remains elevated and does not make contact with the ground below. This situation causes all of the patient's weight to rest on the arch itself rather than on the floor. Therefore, the ball of the foot area will be placed under undue strain and pressure. This is a serious situation because so much weight on the big toe area can cause the sesamoid bones to become compressed. After this, sesamoiditis is a likely outcome and is accompanied not only by the usual pain, inflammation, tenderness and swelling, but may also involve actual deterioration of the structures in the foot.
  • A final non-behaviorally based cause of sesamoiditis is a first metatarsal that is plantar flexed. In this situation, the first metatarsal head is not aligned properly. It will tilt downwards at the front of the foot when it should be lying straight and level. This misalignment causes additional pressure to be borne by the sesamoid bones whenever the patient is engaged in a weight bearing activity. Like fallen arches, over time this can lead to not just typical sesamoiditis, but also deterioration of the sesamoid bones themselves.

 

Symptoms of  Sesamoiditis

The development of symptoms in this condition usually takes quite a while. Most symptoms will be centered under the first metatarsal head, which is located just behind the big toe. Although there is some variation in patient experience, most sufferers of  sesamoiditis will have to deal with these common problems that signal the onset of the condition.

Early Symptoms of  Sesamoiditis

  • Patient experiences pain in the sesamoid bones, particularly when direct pressure is brought to bear on them.
  • Pain tends to quickly fade and go away when the patient rests the sesamoids.
  • Walking in shoes with thin soles causes mild levels of pain.
  • Walking barefoot can also cause mild discomfort.
  • Pain increases when patient engages in vigorous activity such as running and jumping.
  • When the sesamoids feel painful or tender, there may be mild swelling in their general vicinity.
  • Swelling tends to go down if the patient will rest and elevate the foot above heart level.

Progressive Symptoms of  Sesamoiditis

As the condition continues, symptoms will tend to get worse and cause the patient more discomfort and interference with normal activities and a high quality of life. These later stage symptoms include:

  • Continuous discomfort and even pain in the sesamoids or in the area that feels underneath them.
  • Pain worsens when the patient applied direct pressure to the sesamoid bones.
  • Well-padded shoes are no longer enough to prevent all discomfort.
  • Walking and running become increasingly painful and jumping may cause excruciating levels of pain. For some patients, jumping may be so painful that it is no longer possible.
  • Bending the big toe upwards toward the ceiling also causes pain.
  • Swelling grows progressively worse until it may become a constant condition not amenable to subsiding when the patient rests or the foot is elevated above the patient's heart level.
  • In the final stages, the big toe may become very stiff and resist being bent at all. This will result from extreme swelling that may consume the entirety of the first metatarsal joint.

Sesamoiditis is characterized by the gradual onset and development of the symptoms explained in detail above. The same symptoms may occur suddenly and with no warning, but in this case, they will probably not be indicating a diagnosis of  sesamoiditis. Abrupt onset of symptoms is more likely to be associated with a fracture of one of the sesamoid bones or possibly even both. This is particularly true if the patient has recently sustained an injury to the front area of the foot.

Prevention of Sesamoiditis

The best treatment for sesamoiditis is to prevent the condition from ever developing in the first place. While nothing can be done about genetic predispositions and foot defects, even in these cases patients can help prevent these factors from leading to the development of the condition.

The most important issue here is choice of footwear:

  • Don't go barefoot.
  • Wear shoes that support the foot adequately:
    • wide enough to avoid cramping the big toe and ball of the foot area
    • long enough to accommodate your feet
    • thick, padded sole to cushion the sesamoids
    • no high heels – in fact, no heels taller than an inch or even half an inch

Treatment Options – Home Care

Unless the condition is very severe or worsens suddenly, home care for sesamoiditis is usually adequate.
Home care for sesamoiditis involves dealing with the immediate symptoms of the condition. Good home care treatment for inflamed sesamoids follows standard practice for all sorts of repetitive stress injuries in the foot:

  • Stay off your feet as much as possible to allow the sesamoids to rest and recover from the damage.
  • Soaking in warm water can help the patient deal with pain and inflammation, but if it worsens the condition, eliminate soaking immediately.
  • Oddly enough, ice is also an effective home care treatment for sesamoiditis. Apply ice whenever the condition is aggravated but especially after any vigorous exercise. Apply the ice to the bottom of the foot for 10 or 15 minutes no more than twice daily. This should help pain and inflammation to decrease.
  • Wear adequate shoes during the treatment period and then beyond to prevent any recurrence (see the "Prevention" section for specific guidelines about shoes).
  • Provide the sesamoid bones with extra cushioning by means of a gel insert pad in your shoe.
  • Use a topical pain reliever and massage it into the bottom of the foot twice a day.
  • Use over the counter medication to deal with pain. Good choices include the NSAIDs including ibuprofen and sodium naproxen, both available in inexpensive generic formulations. A side benefit of these medications is that they also tend to reduce inflammation – they are called anti inflammatories for good reason.

Treatment Options:  In the Long Run

It may become clear after an extended period of home care that you need more intensive treatment options. In that case, custom orthotics may be the answer. You should see a health care professional who specializes in helping patients obtain and manage custom orthotics. The purpose of these shoe inserts – which will be designed to exactly fit your foot's individual needs – is to redistribute weight inside the shoe so that you are not stressing the sesamoid bones any more than is truly needed.
Objective of custom orthotics include:

  • providing support to high arches
  • lifting up a plantar flexed first metatarsal so it won't bear more than its fair share of weight
  • general foot stabilization
  • providing adequate levels of shock absorption for the arches

The major features of orthotics that help achieve these objectives are:

  • wedges placed in strategic locations
  • heel cups that are wide and deep
  • posts that serve as stabilization points to support the foot



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