What is it?
Sesamoiditis is inflammation of the sesamoids and surrounding tissue. The bones can also develop stress fractures or acute fractures, and some people have naturally split (bipartite) sesamoids that can be confused with fractures.
What causes it?
- Running, dancing, and jumping
- High heels
- High-arched feet
- A direct fall or landing on the forefoot
What does it feel like?
- Pain under the big toe joint
- Pain bending the big toe upward
- Swelling or bruising under the joint
How is it diagnosed?
Exam and X-rays, sometimes with special views. MRI or CT may be needed to distinguish a fracture from a bipartite sesamoid or to look for poor blood supply.
When should you see a podiatrist?
- Pain under the big toe lasting more than a week
- Pain after a jump or fall
- Pain that stops you from pushing off
Nonsurgical treatment
- Offloading pads
- A dancer's pad or orthotic cut-out.
- Stiff-soled shoes or boot
- Limit bending at the joint.
- Taping
- Restricts motion of the big toe.
- Activity modification
- Reduce impact while the bone settles.
When is surgery considered?
Surgery is uncommon and considered for fractures that do not heal or persistent pain after extended conservative care.
Options include fixation of a fracture or removal of part or all of a sesamoid, with careful attention to preserving big-toe function.
What is recovery like?
Conservative treatment may take several weeks to a few months. After surgery, recovery typically includes a period of protected weight-bearing.
Frequently asked questions
Are sesamoid fractures slow to heal?
They can be, because of limited blood supply and constant loading. Early offloading helps.