Bones in the human body are mostly connected at joints, which enable you to bear weight and perform movement. However, there are certain bones that don’t require a joint, instead they are connected to tendons or encased in muscles. Beneath the base of the big toe, there are two small bones enclosed in the tendon of the Flexor Hallucis Brevis muscle. These bones are referred to as the Sesamoid bones. The duties of the sesamoid bones are to protect the tendon of the flexor hallucis longus muscle, increase muscular strength by providing mechanical advantage, and bearing most of the weight on the inside foot.
When the sesamoid bones become inflamed as a result of overuse or injury, the condition is referred to as sesamoiditis. It occurs in the metatarsophalangeal joint of the forefoot causing pain and discomfort. Sesamoiditis is a common issue among young people, particularly those that engage in physical activity such as running, sports and dancing. Any activity that repeatedly requires pushing off the toe must engage the sesamoid bones, and overuse can eventually lead to irritation, inflammation or fracture.
Causes of Sesamoiditis
Injuries affecting the Sesamoids can occur in various ways, including stress fracture, sprain, trauma, or damage between the bipartite sesamoid bones.
A stress fracture in the sesamoid bones occurs frequently in sports or physical activities where quick and delicate changes in direction are required. Examples include basketball, tennis, badminton, and soccer. Traumatic fractures, on the other hand, refer to a single traumatic impact on the sesamoid bones. An X-ray is generally useful in confirming or ruling out any type of fracture.
Overpronation, or “rolling in” of the foot as you walk, is considered a risk factor for sesamoiditis. This condition causes horizontal displacement or movement of the sesamoids. As a result, there is abnormal wear and tear beneath the first metatarsal bone of the foot.
Symptoms of Sesamoiditis
Sesamoiditis is readily differentiated from other similar forefoot injuries by its gradual onset. Pain usually starts as mild in nature, but worsens with an increase in activity level. Or, the patient may experience pain is certain types of shoes. Though not always present, bruising or redness of the toe may indicate sesamoiditis.
Because sesamoiditis is a state of inflammation, it’s important to cease any activity that can continue to place unnecessary strain the ball of the foot. In many cases, a period of rest serves as an opportunity for swelling to diminish and healing to occur. You can self-manage this rest period and monitor for signs of improvement.
Cold therapy treatment can also be used to ease pain and inflammation. If it is safe for you to do so, you may consider NSAIDs (non-steroidal anti-inflammatory drugs) such ibuprofen, to ameliorate pain and inflammation symptoms.
If pain persists, you should see a foot specialist to rule out fractures, ischemic necrosis, or other potential underlying conditions. A podiatrist can provide such a diagnosis and offer appropriate treatment. Some of these options include custom orthotics to cushion the sesamoid area, pain medication, immobilization through a cast or boot, or even stem cell injections to regenerate tissue if applicable.
Surgery is only recommended or required if other methods are not successful.
For instance, in cases of improper healing of stress fractures, surgery can be performed to pin the bones together.
Pain beneath the base of the big toe can be debilitating and often points to issues that can affect the long-term health of your feet. Count on Houston podiatrist Gabriel Maislos, DPM, FACFAS to identify the root cause of your chronic pain and provide the right treatment to help you get back on your feet. Take the first step…call (713) 541-3199 to schedule an appointment with Dr. Maislos. At Houston Foot and Ankle Care, we accept most major forms of medical insurance, and offer affordable cash pricing for those who are uninsured or under-insured.
Call (713) 541-3199 if you experience:
- dull, chronic pain beneath the base of the big toe
- increased pain with higher activity levels
- redness or bruising at the base of the big toe