Sesamoiditis
Pain to either the tibial or fibular sesamoid bone on the bottom of the foot related to excessive pressures or injury to the big toe joint region.
Symptoms
- Pain without swelling to the bottom of the first metatarsalphalangeal joint on the noted during walking activity
- Pain typically worse with lifting the heel off of the ground during the normal walking cycle
Treatment
- Anti-inflammatory medications like Ibuprofen or Naproxen
- Ice daily to twice daily
- Removing pressure at the bottom of the sesamoid region with the use of temporary orthotic with dancers padding modification
- Compliant use of shoe with over the counter or custom orthotic to offload the sesamoid region
- No barefoot walking until symptom-free
Sesamoid fracture
Pain to either sesamoid region often times related to overuse injury. Repetitive abnormal stress to either bone can lead to a fatigue fracture of the sesamoid bones.
Symptoms
- Pain with swelling to the bottom of the first metatarsalphalangeal joint noted during walking activity
- Pain typically worse with lifting the heel off of the ground during normal walking cycle
Radiology
- Possible identifiable fracture noted to the involved sesamoid bone with non-painful foot used as a comparison to painful side
- If x-rays are negative for fracture than MRI can be useful in confirming diagnosis
Treatment
Different treatments based on clinical presentation and length of time symptoms have been experienced. All fractures need to be offloaded with reduction of pressure and motion at the fractured bone to facilitate healing. The sesamoid bones have a limited vascular supply and have high pressures from weight bearing and a large amount of motion which can create a difficult environment to heal the fracture. There is a high rate of delayed healing and non-healing of these fractures.
