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Sesamoiditis

The foot is composed of 26 major and 2 minor bones. That means, your two feet have 25% of all the bones in your body. In addition to these bones, each foot contains thirty-three joints. Five of those joints are made of the bones in the ball of your foot. These are called metatarsal phalangeal joints, or MTPJ’s for short. These joints allow your toes to bend upward, or what is called dorsiflexion. You create this movement by rolling up onto the ball of your feet. Although this movement seems simple, it’s one part of a more complex system of joint movements designed to stabilize your feet as you walk and run.

What are sesamoids?
Sesamoids are two small bones situated on the bottom of the big toe joint (1st metatarsal phalangeal joint, MTPJ). These sesamoids are located next to each other, or side-by-side, and contained within separate tendons that flex the big toe down. The top surface of each sesamoid is covered with cartilage to help it glide across the bottom of the 1st metatarsal bone in the foot. They function to protect these tendons and to provide a mechanical advantage to the flexion of the toe. In most individuals, these bones form around age of 8-10 years. Further, each sesamoid can form as two separate pieces rather than one in a small portion of the population. When this occurs, it is called a bipartite sesamoid.

What is sesamoiditis?
Sesamoiditis occurs when one of these small bones becomes injured. Excess fluid will occur in or around the sesamoid. This fluid, or inflammation, causes pain in the joint that is most noticeable when the toe is bent or pressure is applied to the bottom of the joint. Sesamoiditis is a precursor to a sesamoid stress fracture.

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How does sesamoiditis occur?
Sesamoiditis occurs when excessive force is applied to the 1st toe joint. This can happen with plyometric activities such as running, jumping, cross-training, basketball, volleyball, etc. In addition, repeated bending of the joint can create excess tension in the tendons that attach to the sesamoid, thus leading to sesamoiditis.

How is sesamoiditis diagnosied?
A clinical examination will reveal pain with pressure against the sesamoids. Pain with joint movement is often present as well. X-rays are normally used to help in the diagnosis of sesamoiditis. In order to see the sesamoid injury, an MRI is often needed.

How is sesamoiditis treated?
The basis of treating sesamoiditis involves reducing tension in the tendons that attach to the sesamoids and reducing direct pressure when standing. Anti-inflammatory medication and cortisone injections are effective in reducing inflammation and pain. Ice can help reduce local pain, but does not affect the actual sesamoid bone. One key component to sesamoiditis treatment is reducing movement of the joint. Stiff sole shoes, a surgical shoe, and sometimes a walking boot are used to limit joint movement and joint pressure. Treatment may also include orthotics to off-weight the toe joint. Rarely would surgery be necessary but can be useful in cases when the pain does not respond to reasonable conservative treatment. Surgery often involves removing the affected sesamoid.

When can I return to running?
The goal of rehabilitation is return you to running as soon as is safely possible. If you return to a full training load too soon, the injury may return or worsen. Everyone recovers from injury at a different rate, so don’t compare your rehabilitation to other runners. Returning to running is determined by how well your joint responds to treatment rather than a set number of days or weeks. In general, the longer you have had the symptoms, the longer it will take you to recover. Here are some general guidelines for a full return to running. Keep in mind, some runners may not have to completely stop running, but merely reduce their training load (distance, intensity, frequency) during the rehabilitation process.

  • You should be able to bend and straighten your 1st toe joint without pain.
  • The joint should not be swollen.
  • You should be able to jog in a straight line without limping.
  • You should be able to sprint without limping.
  • You should be able to perform 45-degree and 90-degree cuts without difficulty.
  • You should be able to jump on both legs without pain.
  • You should able to jump on the injured foot and ankle without pain.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.