Sesamoiditis, also known as inflammation of the sesamoid bone of the big toe, is a common cause of big toe pain in runners. Generally, it is essential to distinguish this problem from other problems that affect the big toe, such as big toe arthritis or gout. In addition, the sesamoid bone can be a bipartite sesamoid or a stress fracture. So, how does sesamoid bone pain present, and how do we treat it?

What is a sesamoid bone? 

sesamoditis

Typically, we all have two small bones under the big toe called sesamoids (medial and lateral). Occasionally, a few of us may be missing one or both of our sesamoids. Also, the bones can be split into two parts, also known as bipartite. These bones are essential to help you push off from your big toe when walking fast or running.

Diagnosis of sesamoiditis 

Sesamoid pain can occur suddenly after trauma or gradually with excess activity. For example, trauma like a fall on the toe can fracture the sesamoid bone. Extra training can lead to bone swelling and sesamoiditis. Eventually, further swelling may lead to a stress fracture.

Typically, people report pain in the undersurface of the toe. Generally, pain is worse with impact activities such as walking, marching, and running. Moreover, the sesamoid bones are tender to touch. Therefore, it is essential to rule out other causes of big toe pain, such as arthritis or gout.

Diagnosis is confirmed with imaging. Typically, we perform weight-bearing X-rays to view the sesamoid bones. Sometimes, we use other tests such as ultrasound or MRI to ensure sesamoiditis and exclude other causes.

Treatment of sesamoiditis

foot treatment

In general, treatment is conservative in almost all cases.

Firstly, rest from activities such as running is essential to reduce the load on the sesamoid bones. Secondly, anti-inflammatory treatments such as ibuprofen tablets and ice can help. In addition, alteration of footwear minimises the load on the sesamoids. Often, we use a walking boot for 4-6 weeks to reduce acute inflammation. Then, custom-made orthotics can help shift the forces away from the medial sesamoid.

Generally, recovery is prolonged and can take up to 6 months. Therefore, we try a cortisone shot for sesamoiditis in challenging cases that fail to settle. However, we need to be careful with a cortisone shot as damage can be done to other structures, such as ligaments or tendons in the undersurface of the toe.

Finally, surgery is only reserved for cases that fail all other treatments.

More about sesamoid cortisone injection

In general, we discourage injections for sesamoiditis. However, in cases that fail prolonged rest, a targeted cortisone shot for sesamoiditis is. Cortisone injections help to reduce swelling in the bone and surrounding soft tissue. Therefore, we target both the inflamed sesamoid and the big toe joint.

Typically, we do injections with ultrasound to help guide the injection and avoid injecting into essential structures such as tendons.

Other frequently asked questions about sesamoiditis:

How long does sesamoiditis take to heal? 

Generally, the healing of sesamoiditis is slow. We ususally see complete recovery over 3-6 months, but sometimes longer.

What is a bipartite sesamoid? 

Sometimes, the bones of the sesamoid are slit into two parts. We call this split bipartite. On occasion, pain can occur in a bipartite sesamoid. Treatment is similar to sesamoiditis.

Final word from Sportdoctorlondon about sesamoid bone pain

Sesamoiditis is a slow and frustrating condition. Often, people take at least 3-6 months to return to sport. Overall, you should avoid surgery at all costs.

Related conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.