Sesamoiditis (Ball of Foot Pain)

Sesamoids are bones embedded into a tendon. Sesamoids can be found in many joints throughout the body. The sesamoids in the foot look like two little pea-shaped bones that can be found within the ball of the foot, on the underside of the big toe’s joint.

These bones act like a pulley for tendons, they aid the big toe with mobility and provide leverage to the big toe while running and walking, especially while “pushing off”. The sesamoids also help to act like a weight-bearing surface and alleviate tension to the first metatarsal bone, this absorbs any weight to the ball of the foot while running, walking, and jumping. All of these activities can cause serious pain in ball of foot.

Sesamoid injuries can involve the tendons, bones, and surrounding joint tissue. These injuries injuries are often incurred while participating in activities that require increased pressure on the sesamoids such as running, football, basketball, golf, ballet, and tennis. Additionally, patients with a high foot arch have increased risk of developing sesamoid problems. Wearing high heeled may also contribute to these problems.

Picture of Sesamoiditis

Sesamoid Injuries

The are three possible sesamoid injuries that can occur within the foot:

  • Turf toe. This injury affects the joint of the big toe’s surrounding soft tissue. This is a result of the big toe’s joint being extended well beyond what is normal. Turf toe will cause immediate swelling and sharp pain. It usually affects the entire joint and can limit the motion of the toe. A “pop” can sometimes be felt at the time of the injury.
  • Fracture. This is either an acute or chronic break in the bone. An acute fracture can be caused by trauma or some time of direct impact with the bone. Acute sesamoid fractures will produce immediate swelling and pain at the site of the fracture, but normally do not affect the whole joint. A chronic fracture is a hairline break that is normally caused by continual stress or overuse. This type of sesamoid injury will produce pain within the ball of the foot. This pain will usually come and go and is usually aggravated by activity and alleviated with rest. Fractures will usually cause immediate pain in the ball of the foot.
  • Sesamoiditis. This condition is a result of overuse and involves chronic inflammation within the sesamoid bones as well as the tendons that interact with those bones. Increased pressure on the sesamoids is attributed to causing sesamoiditis. The pain will come and go, and certain activities and shoes might contribute to the pain.

Symptoms of Sesamoiditis:

  • Straightening and bending the big toe may be difficult and cause pain.
  • Bruising and swelling could also be present
  • Pain, particularly under the big toe and ball of the foot. Pain may progress gradually with sesamoiditis, where as fractures will cause immediate pain

Let Us Help You

As director of the Colorado Foot Institute, Dr. Mechanik is Board Certified in Foot Surgery and Board Certified in Reconstructive Rear Foot and Ankle surgery. He has the medical and surgical skills to treat your foot conditions. He and his family are natives of the Denver area.

Dr. Mechanik received his Doctor of Podiatric Medicine (DPM) from the the Dr. William M. Scholl College of Podiatric Medicine which is part of the Rosalind Franklin University of Medicine and Science, a national leader in medical education.

Dr.Mechanik then went on to complete a twenty-four month post-graduate residency training program in Foot and Ankle Surgery.

Dr. Mechanik is a Fellow of the American College of Foot and Ankle Surgeons and a  Diplomate, American Board of Podiatric Surgery.  He is Board Certified in Foot Surgery and Reconstructive Rearfoot/Ankle Surgery.

Diagnosis

Dr. Mechanik will perform an examination to determine whether or not there is tenderness along the sesamoid bones. He may also slightly manipulate the bone and have you straighten and bend the toe. Dr. Mechanik will gently bend the toe toward the foot to assess the point and intensity of discomfort.

Dr. Mechanik may recommend x-rays to ensure proper diagnosis. Many patient’s sesamoid bone will have two parts, this is known as bipartite. Since the edges of the bipartite sesamoid are usually smooth, and fractured edges are generally jagged, X-rays can be very useful in ensuring proper diagnosis. X-rays of your other foot may also be requested to compare bone structure. If the X-rays seem normal, a bone scan may be needed.

Ball of Foot Pain Treatment

Non surgical treatment is always the first option for sesamoid injuries. The following are conservative methods used to treat the injury and depend on severity:

  • Taping, padding, or strapping. Padding may be applied inside the shoe to alleviate pressure to the inflamed sesamoid area. The toe may also be strapped or taped to relieve tension.
  • Immobilization and nonweight-bearing. A cast or cast-like walking boot may be applied. Crutches may also be recommended to help keep weight off the foot.
  • Oral Medications. Anti-inflammatory drugs can be very helpful in reducing inflammation and pain.
  • Physical Therapy. Physical therapy, including range-of-motion exercises, strengthening, and conditioning, as well as ultrasound therapy may follow immobilization.
  • Steroid Injections. Cortisone injections can aid in the reduction of pain and inflammation.
  • Orthotic Devices. Custom inserts might be recommended for long-term treatment. This will help to balance the tension applied to the ball of the foot.

Surgery is generally a last resort, reserved for severe sesamoid injuries that do not respond to the more conservative treatments. Dr. Mechanik will evaluate your condition and discuss these options with you and together you will determine a plan that will suite you best.