Sesamoiditis is a type of tendonitis that occurs in those who spend a lot of time on their toes, namely runners, catchers in baseball and dancers.
To understand sesamoiditis, we need a brief biology lesson. The body has several “sesamoids,” which are small bones that are not connected to other bones, but are instead connected to tendons or muscles. Two tiny sesamoids, which are about the sizes of a pencil eraser, are located on the bottom of the foot near the big toe. They're actually located within the tendons and act as a pulley to increase the tendon's leverage over the big toe. They help the foot bear weight and the big toe to function. When the tendons that surround these sesamoids become inflamed, that's sesamoiditis.
Symptoms usually come on gradually and include pain under the big toe where it meets the forefoot, discomfort in moving the big toe, tenderness, swelling and bruising or redness. The pain starts out as a dull ache and will increase to an intense pain or even throbbing during activity.
To diagnose sesamoiditis, we conduct a thorough physical examination of the foot. We'll move the foot around and put light pressure on areas around the sesamoids to determine exactly where the pain originates. If sesamoiditis is suspected, we'll likely conduct X-rays and possibly a bone scan.
There are a few treatment options for sesamoiditis, starting with rest. The tendons need a break from the activity that is causing the inflammation, so we'll prescribe rest and possibly ice therapy. We might also recommend changes in your shoes, taping, shoe pads to cushion the sesamoids, and possibly steroid injections. Laser therapy has been effective in treating this problem. Laser therapy typically decreased your heel pain by 40% in 10 days.
If the X-rays show that the sesamoids have been fractured, we may also recommend orthotics to cushion the bones further and allow the tendons to heal.