Guide To Treating And Preventing Sesamoiditis

Sesamoiditis is an acutely painful condition of the feet. The pain comes from the inflammation of tiny, floating bones found under the big toe called the sesamoid bones. They are called floating because they’re not connected to other bones. Not only are the bones inflamed in sesamoiditis, but so is the tissue that supports them and helps the big toe flex. Because of this, the pain is found beneath the big toe and in the ball of the foot. The two main causes of the condition are abnormal pressure on the sesamoid bones, which do not structurally support the foot, and walking or landing on the ball of the foot. It is not surprising sesamoiditis is often seen in ballerinas.

Here are some ways to treat and prevent sesamoiditis.

Avoid Triggers

One way to avoid sesamoiditis is to avoid triggers. One cause of sesamoiditis is overpronation, which means the individual’s ankle rolls too far inward and downward when they take a step and keeps rolling even when their toes should be preparing to push off. This puts strain on the big toe and the second toe and causes the foot to twist. Overpronation can not only lead to sesamoiditis but can also cause the foot to become unstable and put the individual at risk for shin splints and pain in the knee. Other sesamoiditis triggers are walking on tired feet and wearing high heels. To avoid the condition, individuals should walk properly, not walk when their feet are tired, and stop wearing heels. Other risk factors they may have no control over are feet with unnaturally high arches or uncommonly large sesamoid bones.

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Pain Medication

Pain medications can ease the discomfort of sesamoiditis even though they don’t treat the cause of the condition. Many patients only need ibuprofen to ease the pain. Ibuprofen, as an anti-inflammatory, is meant to reduce inflammation. It can be purchased over-the-counter if the pain is not too severe. If the pain is truly debilitating, doctors can recommend stronger pain medication.

Many patients find relief when the doctor injects a corticosteroid into the affected big toe, which also reduces inflammation. It is still important to treat the ultimate cause of the sesamoiditis, of course, because long-term use of nonsteroidal anti-inflammatory medication and steroid injections come with their own side effects.

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Elevate And Ice The Foot

Another way to ease the pain of sesamoiditis is to elevate and ice the foot. Ideally, the foot should be raised above heart level, and this is best done if the individual is lying down and their affected foot is propped up on a pillow. An ice pack or bag of frozen vegetables (such as peas) should be used on the bottom of the foot. Ice should never be placed directly on the skin, and even an ice pack should be wrapped in a light towel to eliminate the risk of frostbite. The ice pack should be applied for about ten minutes at a time, then removed for ten minutes and repeated for twenty-four to forty-eight hours after the individual first feels the pain.

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Orthotics

Orthotics are devices worn on the foot or in the shoe to treat issues involving the feet or ankles. In the case of sesamoiditis, sometimes all that is needed for relief is a felt or foam rubber pad inside the shoe. This supports the foot as it is healing from the condition. Some doctors tape the patient's big toe so it is flexed slightly downward. Doctors may also insert a metatarsal pad in a way that spreads the pressure more evenly around the front of the foot. A metatarsal pad would usually support the big toe. Sometimes plain but sturdy flat shoes relieve some of the strain from the big toe and the ball of the foot. As the patient heals, they can transition to wearing shoes that support their arches, though they should no longer wear high heels.

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Surgery

Surgery is the last option if more conservative treatments don’t work to ease the patient's pain associated with sesamoiditis. A sesamoidectomy takes about one and a half hours and requires an ankle block to numb the patient’s foot. The patient also has intravenous (IV) sedation. The doctor makes an incision less than an inch long at the base of the big toe. Depending on the location of the inflamed sesamoid bone, it could be on the outside or inside of the toe. Then, the tendon covering the bone is opened, and the bone is removed. The tendon is then repaired and tightened, and the doctor sutures the surgical wound and splints the foot and ankle.

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Replace Shoes Regularly

One of the most important steps in the prevention and treatment of sesamoiditis is to replace shoes regularly. Shoes worn excessively will not provide enough arch support and cushioning, and this could create foot issues or worsen existing ones. In particular, doctors recommend replacing running shoes and sneakers regularly; these tend to wear out more quickly than other shoes. For the sake of foot health, individuals need to choose flat shoes or those with a heel of no more than two inches. Generally, shoes with soft soles are most comfortable. Choosing shoes with a wide toe box helps to prevent cramping, and orthotic shoe inserts may offer extra foot support that can be especially helpful for individuals who have to stand, crouch, or lift for prolonged periods at work. If the patient cannot find comfortable shoes or orthotics in stores, podiatrists and other healthcare professionals can recommend shoes specifically designed for individuals with foot concerns; most of these styles are only available through medical specialty stores or doctor's offices. Clinicians can make a mold of the person's foot and create custom cushioning devices patients can place inside their shoes to improve comfort levels.

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Take Shorter Strides

When patients take shorter strides, there is less pressure placed on the metatarsophalangeal joint, one of the key areas that can be painful in cases of sesamoiditis. Unlike with longer strides, shorter ones ensure the foot does not end up behind the body, and this minimizes pain due to taking steps. Clinicians recommend that individuals take shorter strides while running or working out, and patients also need to monitor their stride length during walking and daily activities. Along with shorter strides, some patients may need to change their walking or running form, learning to land with a flatter, midfoot strike. Physical therapists, podiatrists, and orthopedists can evaluate a patient's gait and teach them postural changes that could reduce foot pain. Depending on the severity of an individual's sesamoiditis, it may be necessary to have a rest period prior to gait retraining.

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Alternate Types of Physical Activity

To avoid placing excess pressure on certain areas of the foot, it is beneficial to alternate types of physical activity. For example, patients who attend a dance class several times a week might take a walk on other days. Since individuals who participate in ballet, basketball, and running are at a higher risk of sesamoiditis, doctors may recommend that these activities be modified to reduce the risk of injury, and patients might need to change their activity schedule and the types of activity they perform. Alternating between low-impact and high-impact sports may minimize symptoms for certain patients, and it can also be helpful to participate in swimming and other water-based activities that do not strain the foot. Before deciding on specific programs of physical activity, patients experiencing foot issues should always have a physical exam from a medical professional. The physician can determine what types of foot issues the particular patient might face, and they will recommend exercise options that are safe for the individual's needs and will not aggravate any existing foot concerns.