Sesamoiditis

Sesamoiditis is an inflammation of the sesamoid bone and the associated tendons. It is commonly seen in ballet dancers, sprinters and basketball players. It is an overuse injury caused by an increased pressure over the sesamoid bones resulting in a chronic inflammation.

Sesamoids are a special type of bone that are found in the knee, wrist and behind the big toe. Unlike other bones of the body, these bones do not articulate with other bones but are present under the tendons or embedded in the muscles. They provide a smooth surface over which the tendon can glide, increasing their ability to transmit muscle force. The knee cap or patella is the largest sesamoid bone in the body. Two small sesamoid bones are found on the underside of the big toe.

Causes

Trauma or injury is the most common cause of sesamoiditis; an injury to the soft tissues around the big toe joint and the sesamoid bone can result in sesamoiditis. Any acute injury such as muscle pull, ligament sprain, fracture of the sesamoid or the surrounding bones and a dislocation of the neighbouring joints can result in sesamoiditis. Repetitive stress or chronic overuse can result in a stress fracture of the sesamoid bone which can be a cause of persistent pain. Sometimes a condition called osteonecrosis, caused by a lack of blood supply to the bone, can give rise to sesamoiditis. Frequent use of high heel shoes can aggravate the condition.

Symptoms

A dull, longstanding pain is the predominant symptom of sesamoiditis. Usually the pain is gradual in onset but in cases of fracture the onset of pain is sudden. Pain is aggravated by movement of the affected body part or any pressure over it. In some cases swelling and bruising may be present.

Diagnosis

A thorough physical examination is essential for the diagnosis of sesamoiditis. Your physician will check for tenderness and aggravation of pain on movement. The examination helps evaluate the type and cause of the injury. X-rays may be ordered to confirm the diagnosis. In case an X-ray is inconclusive your physician may order a bone scan.

Treatment

Usually the treatment of sesamoiditis is non-surgical. In very rare cases, surgery is considered when the non-surgical approach fails to provide any benefit.

The non-surgical treatment options include

• Immobilization: Take adequate rest and place the foot in a removable cast. Avoid activities which cause pain. Crutches may be used to avoid weight bearing on the affected bone.
• Padding and strapping: A pad may be used to cushion the inflamed area. Strapping can be used to relieve the muscle tension around the inflammation.
• Physical therapy: Some exercises such as range of motion exercises and strengthening exercises may be advised to improve the condition. Ultrasound therapy can also be helpful in relieving pain.
• Orthotic devices: Some orthotic devices such as special shoes that cushion the injured area can relieve the pressure over the affected sesamoid.
• Oral medications: Non-steroidal anti-inflammatory (NSAIDs) medications may be used for the reduction of pain and inflammation.
• Steroid injection: Sometimes a steroid injection may be used to reduce the pain.

Prevention

A recurrence of the sesamoiditis can be prevented by following a few simple measures which include:

• Use appropriate shoes with proper padding.
• Follow physical therapy for improving gait and strength.
• Avoid the use of high heel shoes and other activities associated with aggravation of pain.