Hello, and welcome to this episode in our series. Today, we’ll be talking about a commonly seen condition that causes pain and discomfort underneath the big toe. This is known as sesamoiditis. The sesamoids are two small bones that are located underneath the big toe. They lie within the tendon that runs through the arch, and inserts into the big toe.
They have a similar function to the kneecap, in that they help leverage these tendons. Because of the sesamoids location, and their function being to push the body forward during each step, there’s large amounts of pressure that go through them during every path of our go cycle.
Sesamoiditis is a condition which causes pain and inflammation at the sesamoids, and it generally causes pain underneath the big toe, or on the ball of the foot. In some cases, there may be a fracture present, but this is different to sesamoiditis. Certain factors make people more at risk of developing sesamoiditis. Say some sports particularly, so sports that involve lots of jumping, such as basketball and netball.
Also dancing, where we’re raising up onto our toes regularly. Sprinting is another sport that increases our risk of developing this condition,
and even just walking can increase our risk factor. People with very arched foot types or very low arched foot types are also more prone to this condition, and people with tightness in certain muscle groups, as this increases full foot loading.
The other risk factor is people that spend long hours on their feet, and particularly on hard surfaces. Sesamoiditis is diagnosed by manual palpations. This is generally done by a podiatrist in the clinics here. Your podiatrist will locate the sesamoids and manually palpate this area. On some occasions, we may need to refer for imaging, so this can involve x-ray, ultrasound, or MRI.
This is to rule out a fracture, and also to determine whether you may have something called a bipartite sesamoid. This is where a genetic variation, where one of the sesamoids is formed as two bones, and people with bipartite sesamoids are more prone to sesamoiditis. Other things that we’ll do is check your range of motions. We’ll look at joint movement and determine if there’s any restrictions in any of the joints in your feet and ankles.
We’ll also look for tightness in certain muscle groups, as this could increase forefoot loading. A full biomechanical assessment will be performed. This involves observing you walk. We’ll look at your foot posture and lower limb biomechanics during your walking cycle. This would determine whether there’s anything that could be increasing loading at this area.
Conservative treatment tends to aim to reduce pressure at this area, so we’d look at prescribing something called a custom foot orthotic, which is a device that you’d wear in your shoes, and that can redistribute pressure underneath the foot. In some occasions where the pain is severe, we may look initially at putting you into a CAM walker or a Moon Boot, to settle your symptoms down, and then transition you into a shoe and orthotic.
For more severe cases, we can sometimes look at referring on to a surgeon, for a surgical review. In some cases surgery may be required to remove a fragmented piece of the bone. But this is generally done if conservative measures aren’t successful. It’s important to have this condition assessed and treated promptly. There are certain risks associated with not having this addressed early enough.
If you are experiencing any sort of foot pain, it’s important to get this seen by a professional. If you’d like to make an appointment with one of our podiatrists, this can be done through our website.