Welcome to the fourth installment of my blog, Surviving COVID-19 without my Podiatrist. Each article provides at home self help guidance to common foot ailments.The information provided in our blog is not intended to be medical diagnosis or treatment. The purpose of my blog is to help the reader better understand their foot condition during the current pandemic where access to medical care can be limited.

If you have any further questions about this topic, as well as any other subject you would liked addressed, please email me at drreyes@ngfootclinic.com.

Sesamoiditis

Sesamoiditis is perhaps one the most misdiagnosed conditions affecting the foot. It is commonly described as acute or chronic pain under the great toe or forefoot. The reason you don’t hear much about it is because it tends to be associated more with high performance athletes. However, in my 28 years of practice, I have seen it in a wide variety of patients, from athletes to grandmothers.

So what is it and why should I care?

When we see the human skeleton, you will notice that the majority of our bones are connected to one another. However, there a few bones that are not connected to any other bone. They are either connected to tendons or are embedded in muscle. These bones are known as sesamoids. The most well known sesamoid is the kneecap (patella). There are two other less known sesamoids about the size of a pea located on the bottom of the forefoot, near the great toe. One is located on the outer side of the foot, the tibial sesamoid, and the other closer to the middle of the foot, the fibular sesamoid.

Sesamoids are the body’s pulleys. They provide a smooth surface over which tendons can slide, allowing tendons to transmit muscle force. The two sesamoids of the forefoot mentioned earlier also assist with weightbearing and help elevate the bones of the great toe. 

Because of their unique anatomy, sesamoids can fracture or receive a contusion if a specific vertical force is applied to them. Furthermore, the tendons surrounding the sesamoids can become inflamed. These different conditions are considered a form of tendinitis, called sesamoiditis. It has been typically thought to be common in ballet dancers, runners and baseball catchers.

Pretty specific group of people right?

Well, as I previously mentioned in our introduction, I have diagnosed and treated many cases of sesamoiditis in a variety of patients. These patients have often been misdiagnosed with metatarsalgia, capsulitis, neuromas, painful bunions and fibromyalgia to name a few. Many of these patients underwent unnecessary surgeries to treat their misdiagnosed pain. This is why I think it is important for the reader to be aware of this condition.

My 8 Ways to Treat Sesamoiditis at Home

1. Stop whatever activities that are causing the pain.
2. Take over the counter NSAID (advil,naprosyn,etc) medication to reduce pain and inflammation. My advise here is to take an NSAID for at least 3 days at the maximum daily dosage allowed. This is provided you are medically cleared to be able to take NSAIDs.
3. Apply ice for 5 minutes every 3 hours to reduce swelling.
4. Wear low heeled, soft soled shoes
5. Add an inexpensive insole to provide additional cushioning inside your shoes.
6. Do not wear high heeled shoes in order to prevent future irritation and inflammation.
7. Avoid any kind of massaging to the area. If the sesamoid is fractured, or healing, it can be easily dislodged from its position by massaging the area.
8. If after after 3 weeks there is no improvement, you can order a simple short CAM walker from any online vendor (Amazon, e-bay, etc) and begin wearing it when you are weightbearing. This will provide complete immobilization of the area and allow it to heal better.

Patience is golden with this condition. It may take about 6 weeks to relieve the pain. This can also become a chronic condition, where the patient’s  lifestyle can be significantly affected. It is usually seen when the sesamoid has healed poorly, causing it to be enlarged or disfigured. This condition is usually called a hypertrophic sesamoid.

Surgery to remove a hypertrophic sesamoid is often advocated either as part of a bunion correction or as a single procedure. I personally don’t recommend this approach because the removal of the sesamoid can seriously affect the foot’s function and could lead to other painful conditions.

Additionally, there is now a new modification that can be added to custom molded orthotics in order to alleviate this condition without the need for surgery.

I hope this article contributes to your well being until you can see your podiatrist. If your symptoms don’t improve, or worsen, please seek urgent care immediately. If you have any questions I am always available, please feel free to drop a comment here, email me or send me a DM through any of my social media pages.