Sesamoid Injuries

Sesamoid Injuries / Sesamoiditis

To understand sesamoid injuries in the foot, it’s important to know what a sesamoid is. A sesamoid is a bone embedded within a tendon. In a normal foot, the sesamoids are two “pea” shaped bones located in the ball of the foot below the great toe.

The sesamoid bones have a very important role in big toe joint, 1^st metatarsophalangeal joint, function. They protect ligaments, help to distribute load, reduce friction and assist with the action of the muscles.

As with most sporting injuries the differential diagnosis of the cause of your problem is important. Sesamoiditis is just one of the problems that can cause pain over the sesamoids. In most instances only one sesamoid will be the cause of the pain and more commonly this is the medial sesamoid. All of the conditions that cause sesamoid pain present with pain and tenderness over the sesamoid with activity and specifically during push off or the propulsive phase of gait. However, they most definitely need to be treated slightly differently depending on the diagnosis.

The differential diagnosis includes

• Sesamoiditis – inflammation of the tissues surrounding the sesamoids
• Symptomatic Bipartite Sesamoids (sesamoid bones made up of 2 or more pieces of bone)
• Sesamoid stress fractures
• Chondromalacia of the sesamoid / 1^st metatarsal joint
• Rare causes including – Infection, gout, inflammatory arthritis

Further investigation may include X Rays or MRI depending on the clinical presentation

Treatment options include

• Padding and Taping
• Load modification
• Footwear selection
• Cam Walker (Moon Boot)
• Orthotics with very specific sesamoid padding (otherwise the orthotics are unlikely to be a complete solution)
• Carbon Insoles
• Anti-Inflammatory medication (NSAID’s)