What is a sesamoiditis?
Sesamoids are small bones which are the size of a kernel of corn found on the undersurface of the foot, in the ball of the big toe. There are two sesamoid bones present in the foot. These bones lie in between the tendons of the foot. They help in the movement of the big toe joint.
Sesamoiditis is a condition where the soft tissues or tendons surrounding these bones get inflamed or irritated.
What causes sesamoiditis?
Ballet dancers, professional athletes and long distance runners may be prone to this condition due to the abnormal stresses placed over the sesamoids during activity. This condition is also found more commonly in people who have a high foot arch (cavus foot)
What are the symptoms caused by this condition?
With sesamoiditis pain may occur gradually. It is localised to under the big toe over the ball of the foot. Swelling may or may not be present. Pain is also noticed on attempting to move the big toe, during bending and straightening of the big toe. If there has been an injury causing a fracture of the sesamoid bone, symptoms will be acute and bruising might also be present. Following as injury this condition is also called a ‘turf toe’
How is this condition diagnosed?
Your consultant will examine your foot clinically and this usually makes the diagnosis clear. The sesamoid bones will be palpated for tenderness.You may experience pain when he attempts to move the big toe joint with reduced range of movement. A special Xray view of your foot called the ‘sesamoid view’ will be taken to rule out a fracture, if there is a history of injury. In some instances, a CT or an MRI scan may be necessary. Blood tests to rule out an inflammatory arthritis may also be done.
Can the condition worsen?
Big toe arthritis may gradually deteriorate over several years. Initially you may experience just stiffness of the big toe but with time pain may also develop particularly on running or walking. As the condition deteriorates one may also get pain at rest.
What treatment options are there?
Options are based on the degree of arthritis in the big toe.
Foot wear modification:
Pain often occurs when the big toe bends upwards during walking.The thinner the sole of the shoe, and the higher the heel, the worse are going to be the symptoms from this condition. Therefore a shoe with a well supported stiff sole, will help reduce the amount of movement of the big toe during walking and help with your symptoms. A ‘rocker-bottom’ shoe may also help as it allows the big toe to rock forward rather than bend during gait. A ‘large toe box’ shoe is preferred to a narrow pointy toe shoe.
Non steroidal anti- inflammatories:
A large number of patients will have good control of symptoms with non steroidal anti inflammatory medicines and may not require anything further.
These can be given for relief of pain in the short to medium term. These can be offered for an acute flare up of symptoms and help by reducing the inflammation in the joints.
Several surgical options are available and your consultant will tailor based on your symptoms and degree of arthritis. ‘Cheilectomy’ involves removing the bony bump at the top of the big toe which usually causes irritation whilst wearing shoes. The big toe joint may either be fused or replaced. Fusion creates a stiff big toe which will be done with a small plate and screws. This eliminates the pain in the big toe but sacrifices movement. This is ideal for young active patients. A joint replacement on the other hand will help preserve movement but the results of a replacement are not as predictable as a fusion. A fusion remains the gold standard treatment for big toe arthritis.
Is surgery necessary?
The decision to proceed with surgery should be taken after non surgical options described above have been exhausted. The majority of patients will benefit from shoe wear modifications and simple painkillers. If symptoms continue to affect lifestyle and function inspite of this then surgery may be discussed with your consultant.