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Sesamoiditis: Pea-Sized Bones, Baseball-Sized Pain

You’ve probably seen a pulley at work. Old wells had them to raise and lower buckets for drawing water. Early steam-powered factories had a giant one overhead and a conglomeration of side pulleys that piggy-backed off the main one to run each machine. What you may not know is that you have two tiny bones in your feet that act in a similar way to pulleys. When the tissues around these sesamoid bones become inflamed, you have a condition called sesamoiditis.

Sesamoids Make Movement Smooth and Easy—Unless They Hurt!

Most of our bones are connected to other bones in joints held together by ligaments. These little pea-sized bones, however, are connected only to the tendons in your forefoot. They lie in the area at the base of your big toe and allow the tendons to glide smoothly over each other with each step. This helps them function more efficiently, transfer power from muscle to bone, and raise the big toe.

These small round bones bear the whole weight of your body (especially if you wear high heels) and can break just like any other bone. They can also transfer trauma to the surrounding tendons and tissue and cause inflammation—sesamoiditis. The inflamed tissue is painful, and may or may not be swollen and bruised. The pain may be so severe that you are unable to bend your big toe.

To diagnose this condition, the doctors at Country Foot Care will examine and manipulate the sesamoid bones and have you try to move your toe—or move it for you—to see the location and extent of the pain. We may also perform digital X-rays or a bone scan fluoroscopy to see if there is a fracture.

How to Treat Sesamoiditis

The first thing to do when you notice the inflammation and pain is to stop the activity that is causing it. Runners, dancers, baseball catchers, painters standing on ladders—no matter what your role, you will need to give it up for a bit. The pain probably came on gradually and you thought it would go away again, but it won’t until you’ve rested and let the tendons heal.

Before any treatment plan is initiated, your foot needs to be evaluated to rule out a possible fracture.  Early treatment includes icing the area and taking a mild pain-relieving anti-inflammatory medication if you can. Comfortable, low-heeled shoes of soft material with plenty of cushioning are the best styles to wear during recovery. Stiff-soled shoes may also help, because they don’t allow the toe joint to move as much so the injury is not aggravated. Alternatively, you can buy pads to cushion the area as well.

Physical therapy and custom orthotics may bring some relief as well. In difficult cases, we may recommend injecting a steroid medication into the painful area or wearing a removable walking cast that holds the leg and foot steady while the condition heals. If the pain is severe and doesn’t respond to these more conservative measures, surgery to remove the sesamoids is a final option. Once the sesamoiditis has subsided, don’t be too quick to jump back in to your former activities. “Slow and easy” is your motto if you want to avoid re-injuring the area.

For all of your foot problems, Country Foot Care provides expert diagnoses and effective treatments to reduce your pain and get you back on track. Don’t hesitate to call our offices to set up an appointment or, if you prefer to do so online, you can click on the MAKE AN APPOINTMENT button at the top of this page and one of our courteous staff will call you to finalize the time and date.