Sesamoiditis Foot Pain in the Big Toe

Sesamoiditis Foot Pain in the Big Toe

Sesamoiditis Foot Pain in the Big Toe is usually the result of falling very hard on your big toe! The tibial sesamoid is the one most commonly irritated!

Sesamoiditis Foot Pain in the Big Toe
Sesamoiditis Foot Pain in the Big Toe
  • The sesamoids are located centrally and plantar to the first metatarsal head where they are imbedded within the plantar plate. There are 3 sesamoids associated with the great toe joint; 2 are considered constant and lie beneath the first metatarsal head, and the third, referred to as inconstant, when present develops inferior to the hallux interphalangeal joint (HIPJ).
  • The function of the sesamoids is to absorb and disperse weight bearing from the metatarsal head. This function in turn provides protection to the flexor hallucis longus (FHL) tendon.
  • Tibial(inner) sesamoid is larger & bears more weight, thus it is more likely to fracture.

Clinical findings

  • Sesamoid disorders account for 9% of foot and ankle injuries and 1.2% of running injuries.
  • The pain may be constant or simply aggravated by weight-bearing activity.
  • Burning, radiating, or pins-and-needles sensation may indicate neuritis incited by edema, inflammation, or by a displaced fracture

Physical examination

  • Direct Palpation usually elicits pain, also moving the sesamoids around causes sevre pain.
  • A high arch foot usually correlates with this.

Diagnosis

  • -Xrays views on weight bearing are usually enough & will show if there is a fracture, rarely is a CT scan needed.

Sesamoiditis

  • a generalized term for a painful inflammatory condition associated with a sesamoid complex devoid of radiographic changes.
  • Physical examination can reveal pain with direct palpation or passive distal push on the sesamoid apparatus, passive bending of the hallux, and pain along the tendons heading toward the big toe.

Non-Surgical Treatment Overview of Sesamoiditis Foot Pain in the Big Toe

  • Rest, ice, non-steroidal anti-inflammatory medications, and custom modified orthoses.
  • Tip: ***This conservative method should take care of the pain very quickly!***
  • These conditions are often caused by repetitive stress, so orthotics will likely be needed to keep the pain from coming back. I suggest some powersteps that cost about 25$ or some gel inserts that go underneath the big toe, or even a cut-out to accommodate the big toe from contacting the ground.
  • -If these methods don’t improve the condition in 6 months – surgery may be needed.
  • -Also make sure there is not a seed corn (intractable plantar keratosis) under the joint, studies show a 89% subjective success of plantar shaving for intractable plantar keratosis.
  • Complications of not treating are: Osteoarthritis, Infection, Intractable plantar keratosis(in a large diffuse callus), sesamoid fracture & Nerve impingement.

Surgical Treatment of Sesamoiditis Foot Pain in the Big Toe

  • If the condition did not improve in 6 months then surgical excision is likely needed.
  • Although isolated sesamoid resection can prove definitive, this procedure is has potential complications- like hallux abductovalgus (bunion).
  • Also make sure there is not a seed corn (intractable plantar keratosis) under the joint, studies show a 89% subjective success of plantar shaving for intractable plantar keratosis.

Sesamoid Excision

  • 2-3 weeks Non-weight bearing
  • Results are very good
  • 3-4cm scar on the inside of your big toe joint

Sesamoid fracture

  • Can occur with trauma or chroinc sesamoiditis that progresses into a fracture.
  • The tibial sesamoid is bipartite in approximately 10% of the population
  • Treatment of Sesamoid fractures is the same as for any stress fracture.