Sesamoiditis: Inflamed Bones and Tendons under Your Toe

James W. Rust
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  One little gear in a clock that jumps out of position or cracks can stop time in its tracks. One little glitch on a DVD can ruin the whole movie experience if it happens in a crucial spot. Likewise, one small pair of bones in your foot can leave you hobbling with sesamoiditis and unable to move around normally, hampering your daily life. Here’s what happens:

Pulleys Gone Kaput

Under your big toe, nestled in the tendons, are two small round bones about the size of peas. They act as pulleys so your tendons can glide and stretch easily as you move your toe, and a fulcrum point for leverage as you push off with each step. They also help support the first metatarsal in your forefoot structure bear your weight.

Facts About SesamoiditisSince these sesamoid bones are used every time you are on your feet, they endure a lot of wear and tear. Conditions like bunions and other biomechanical issues can contribute to the problem. This is especially true if you put increased pressure on your forefoot with running or jumping, such as with sports or ballet dancing, or when wearing high heels for extended periods. The pressure can cause the sesamoid bones and affected tendons to become irritated and inflamed, a condition called sesamoiditis. It is considered an overuse injury, due to repeated motions and pressure over time, rather than an acute injury that damages tissue immediately.

How Do You Feel?

When you have injured these small bones, you will have some degree of pain under your big toe and/or in the ball of your foot. It will usually worsen with activity, or when wearing certain shoes, and then subside when the irritation is lessened. You may have some swelling or bruising, but not always. The joint may also be stiff and hard to bend up or down. If you have dull aching discomfort, but can’t pinpoint an injury that may have caused it, you might have sesamoiditis.

This is different than the sharp pain you may feel if there is a fracture (yes, these tiny bones can break, too!). If the pain is immediate and severe, let our staff have a look to make sure there is there is no stress fracture.

What Should You Do for the Pain?

There are several things you can do to treat sesamoiditis at home. First and foremost, get off the toe and stop doing any activities that hurt it. Your tissues need to rest from activity that causes pain in order for them to direct their energy toward healing. You can try using a thin cloth and ice pack on the painful area to reduce the ache and swelling. We can let you know what type of pain reliever would work best for your situation, and you can elevate the foot above your heart level to reduce swelling.

We can tape the toe into a position that relieves pressure on the sesamoids, or give you steroid injections to reduce swelling and inflammation. We can also show you how to use padding to offload the tender area. The problem usually resolves in three to four weeks, but in some cases, wearing a leg brace for several weeks may be needed to help the bones heal.

Take Time to Recover Slowly

When you are able to move around again, choose footwear that has soft insoles and low heels. Clogs with stiff soles may also help. Don’t jump right back into your activity—build back up slowly, letting your body tell you when it’s ready to move to the next step or when you’ve done too much. We will work with you through your recovery, and following our advice about weight-bearing will be key to how well you heal.

If you have a painful big toe, contact Atlantic Foot & Ankle Associates to find out whether it is sesamoiditis, or something else. With five offices along Florida’s east coast, one is sure to be convenient for you. Call us at one of the numbers below today, and put an end to big problems from tiny bones.