Most of the bones in the human body connect through joints. However, some bones are not connected to bones, but to muscle and tissue. These are often referred to as the sesamoids. Among the largest sesamoids in the body are in the kneecap (patella). Other sesamoids in the body exist under the forefoot, close to the big toe and the other close to the middle of the foot. These bones under the foot are prone to deformities referred to as sesamoiditis. The sesamoids work in the same ways as pulleys in a mechanical system. In particular, these are unique bones that offer a smooth platform over which the tendons can move.
As a result, the sesamoids help to provide improved weight bearing and to elevate the bones that exist on the great toe. Similar to other bones, the sesamoids can be prone to damage. Furthermore, the tendons around the sesamoid can be compromised by issues such as inflammation or irritation. The condition is referred to as sesamoiditis, and it affects close to 4% of the world’s population.
Sesamoid Structure and Function
A significant number of people have two sesamoid bones on either foot. The sesamoids are often located just behind the large toe, under the foot. However, some people have four sesamoids in both feet. The primary function of the sesamoid bones is to provide support for the tendons in the feet. The tendons have the role of regulating the motion of the large toe. Sesamoiditis is a toe deforming that leads to inflammation and issues such as pain in the sesamoids. The pain often comes as a result of the unusual motion of the big toe.
Causes of Sesamoiditis
Various factors can affect the functionality of the sesamoids and to lead side effects such as inflammation. Furthermore, people who engage in regular physical activity are also prone to the condition. This is because the high levels of physical activity place increased stress on the sesamoids. Using the incorrect shoes can also be a leading cause of the sesamoiditis. For instance, the high heels have an unusual weight distribution, which can affect the big toe area. In some cases, issues such as falling over can affect the sesamoids and lead to strange symptoms. However, the leading cause of the condition relates to when a patient drastically increases their level of physical activity.
The sesamoids will usually lead to increased strain on the tendons, along with the small bones that exist in the foot. Even more, the muscles can suffer from inflammation, especially when exposed to increased trauma. The trauma often arises from issues such as wearing high heels. Even more, engaging in physical activity regularly also places increased pressure on the sesamoids.
Signs of the Deformity
Swelling and pain are the main signs of sesamoiditis. People with toe deformity often report that the pain increases during physical activity. The condition differs from other deformities such as the forefoot because it has a gradual onset that relates to various small injuries. Over time, the injuries can accumulate and lead to intense pain for the individual. However, the individual rarely has any visual symptoms that accompany the injury such as bruising or swelling. In such cases, the use of diagnostic imaging techniques might be required to determine the leading cause of the pain. Furthermore, the use of X-ray techniques will be necessary – however, the X-rays are not useful for bone fractures.
The sesamoid bones are prone to damage, and deformities such as sesamoiditis. In some cases, it can be quite challenging to differentiate between the symptoms of the two complications. Usually, the pain will occur when the damage to the sesamoid bone occurs. However, someone with sesamoiditis will experience the pain gradually. Other symptoms associated with the condition include:
- Bruising – the bruising occurs as a result of damage to the bottom section of the foot and inflammation issues
- Problems in stretching the toe – the affected area often experiences pain and swelling, which may be accompanied by pain
- Swelling – swelling is a healthy body response to issues such as injury to a muscle or a bone structure
- Pain in the bottom of the foot – the pain comes about as a result of the damaged bone and muscle structure in the foot
Since the condition develops gradually over time, the individual may experience various issues such as mild pain. The pain will usually occur on the bottom section of the foot and the toes. Furthermore, the discomfort caused by the sesamoiditis can affect one’s natural gait or cause a limp. The person may also have to adjust their body weight to relieve the additional pain and pressure on the foot.
How Is It Diagnosed?
The process of diagnosing sesamoiditis often starts with a medical examination. The foot specialist will evaluate the foot for various issues such as tenderness in the ball of the foot. Usually, the test involves the process of moving the foot around in multiple directions. The limits on the flexibility of the toe and the pain will help the medical professional to diagnose the complication. If the doctor suspects a foot fracture or sesamoiditis, then they might recommend an X-ray test. Broadly speaking, the sesamoids often have smooth edges, and a rough occurrence might signify a fracture. The doctor might also perform a bone scan as part of the diagnosis process. The bone scan is a unique imaging procedure that involves radioactive material to evaluate underlying issues in the foot.
Sesamoiditis will not often require surgery or any other form of medical intervention. Many treatment plans are focused on improving one`s lifestyle.
Being able to limit the physical activity that causes sesamoiditis is highly essential. Activities that place immense pressure or strain in the sesamoids are the leading causes of sesamoiditis. If you are prone to the condition, ensure that you avoid placing excessive tension around the affected area, until you achieve optimal recovery. Furthermore, it’s vital that you avoid any activities that place added pressure on the ball of the foot. Consider using the RICE process whenever you come across any signs relating to sesamoiditis. If you have high heeled footwear or shoes that pressure the sesamoids, then you can also opt for comfortable and supportive footwear. Wearing low heeled and soft sole shoes is a great approach.
If you have foot pain that affects your day to day functions, the NSAIDs might be perfect for your needs. However, remember that you should not use these medications for long durations because it can lead to dependency issues. These medications are strong and your medical practitioner may only prescribe enough for a few weeks. Among some of the commonly used medicines for inflammation include ibuprofen and aspirin. In some cases, a cortisone injection might also be recommended to help regulate the inflammation.
Orthotics and Wearing Proper Footwear
Orthotics are specially developed foot accessories that provide comfort and are useful for managing foot deformities. In particular, the custom foot orthotics are better than the OTC versions in various ways. The custom foot orthotics are beneficial because they relate to your specific body and weight characteristics. Furthermore, the medical practitioner also often develops the orthotics after performing a conclusive medical exam on your foot. Wearing the right shoes is also an essential factor to consider when managing sesamoiditis. The ideal shoe should be comfortable and suitable for wear in different terrains. This is particularly true if you have weak foot muscles, or you are prone to deformities such as sesamoiditis.
If other methods are not productive, then you might have to consider the various surgical options available. For instance, you might require a surgical process to remove one sesamoid bone. It’s only possible to remove one sesamoid because removing both can compromise the performance of the big toe. In most cases, the surgery process often involves the use of anesthesia. The process will also include the placing of incisions at various sections of the foot to separate tissue and bone. The doctor will remove the tissue once the sesamoid has been removed and the reconstructive surgery process is complete.
Other Treatment Options
The mild cases of sesamoiditis usually resolve themselves within a few days of proper rest and treatment. However, some examples of the foot deformity might take longer to heal. If you experience symptoms that don’t subside within a few days, then you might have to consider a removable leg brace. Once the symptoms subside, then you can resume normal activities. You may also have to avoid intense physical activity such as soccer or running until the pain subsides. Ensure that you communicate with a medical health professional about your ability to resume physical activities. The central aspect of optimal recovery is to place less pressure on the sesamoids. Broadly speaking, sesamoiditis can be treated using conventional DIY techniques. The common ones include
- Limiting activities – being able to limit the activities that lead to the pain and discomfort is essential in the healing process. Any intensive form of exercise or physical activity can cause strain on the affected area.
- Consume over the counter medications – over the counter medications help in pain management and the healing process. These medications usually include the use of NSAIDs, pain killers and more.
- Perform the RICE technique – using the Rest, Ice, Compression and Elevation technique is also useful for the healing injured sesamoids
- Avoiding high heeled shoes – wearing high heeled shoes places the foot in an unusual position, thereby leading to sesamoiditis.
In some instances, a medical professional might recommend the use of tape on the large toe, to help relieve pressure and to stretch the muscle. The process is referred to as plantar flexion. Furthermore, the foot specialist might also administer a corticosteroid injection to help manage the pain and to reduce inflammation in the tendons. The medical professional may also recommend the use of a particular leg brace to help control the pressure and pain. It might even take up two months with at home treatments before you eliminate the condition. In the rare case, the symptoms worsen, then you might have experienced a stress fracture. If this is the case, then avoid placing any weight on foot for a few weeks. The doctor might also recommend techniques such as surgery to treat the sesamoid injury, especially if you have tendon damage.
Similar to managing most types of foot deformities, wearing the appropriate footwear is an essential aspect of the treatment process. For instance, investing in shock absorbing shoes that are comfortable is particularly useful for the treatment process. Also, consider replacing any shoes that surpass their average time of use. You might also consider using a supportive insole, or using a special pad referred to as a metatarsal bar. The special pad helps to provide added support to the underside of the foot on the sesamoid bones.
Sesamoiditis sometimes occurs due to issues such as overpronation. The overpronation occurs when the individual`s foot rolls inward, as they make a step. To correct this issue, the individual will benefit from solutions such as balance training. The balance training will help to reduce the pressure and stress on the joints of the foot.
Among some of the conventional techniques to avoid overpronation would be to take short strides and walk properly. Your medical practitioner might also provide some custom orthotics to help manage the health complication. Once your health symptoms improve, consider adjusting your physical activity to manage any sesamoiditis issues. For instance, if excessive running lead to sesamoiditis, then consider engaging in activities such as cycling and swimming – which are low impact sports.
Overall, sesamoiditis is a foot health condition that can resolve itself with a few weeks of proper management and treatment. Usually, the disease is diagnosed when one experiences pain and inflammation in the tendons of the foot. Furthermore, preventing the condition relies on your ability to make the right decisions about foot care. When managing sesamoiditis, consider limiting your physical activity and wearing the appropriate footwear. Using products such as custom orthotics are also useful in the treatment process.