Sesamoiditis: Symptoms, Types, Causes and Treatment

Symptoms of Sesamoiditis

Sesamoiditis can be an elusive condition, often catching people by surprise with persistent pain and discomfort in areas they might not expect. Despite their tiny size, the sesamoid bones play a crucial role in joint movement and weight distribution, making inflammation here both disruptive and painful. Recognizing the symptoms early is key for effective management and preventing long-term complications.

Symptom	Description	Common Location	Source(s)
Pain	Persistent, aching pain	Under big toe joint	1,2,6
Swelling	Localized soft tissue swelling	Forefoot, thumb	4,5
Tenderness	Increased sensitivity to touch	Plantar foot, thumb	2,6
Reduced Motion	Limited joint movement/stiffness	Big toe, thumb	4,6

Table 1: Key Symptoms of Sesamoiditis

Understanding the Symptoms

Sesamoiditis most frequently presents as a dull, aching pain beneath the big toe joint (first metatarsophalangeal joint), especially during activities that put pressure on the forefoot, such as walking, running, or jumping 1,2. The pain may develop gradually and worsen with continued activity, making it a common complaint among athletes and active individuals.

Pain and Its Patterns

• Location: The pain is typically centered under the ball of the foot, directly beneath the big toe joint, but can also manifest in the thumb (hand sesamoids) or, more rarely, in animals such as horses 1,4,5.
• Character: Most people describe the pain as a persistent, throbbing or burning sensation. It can be aggravated by pushing off with the toes, climbing stairs, or wearing high-heeled or thin-soled shoes 1,6.
• Onset: The onset is often gradual, distinguishing it from acute injuries or fractures.

Swelling and Tenderness

Swelling is a less common but notable symptom, particularly if the inflammation is severe or if there’s associated soft tissue involvement 5. The affected area is usually tender to touch, and direct pressure over the sesamoids can reproduce the pain 2,6.

Reduced Mobility

Patients may notice a reduced range of motion in the affected joint, accompanied by stiffness. In chronic or severe cases, joint movement can become notably restricted, impacting daily activities 4,6.

Recognizing Early Signs

• Increased discomfort during or after physical activity
• A feeling of “walking on a pebble”
• Sensitivity when pressing under the big toe or thumb

Catching these symptoms early can help prevent progression to more serious conditions, such as stress fractures or avascular necrosis of the sesamoid bones 2,3.

Types of Sesamoiditis

While the term "sesamoiditis" is often used broadly, there are different types and related disorders depending on the location and nature of the underlying problem. Understanding these distinctions can help guide both diagnosis and treatment.

Type	Location	Distinctive Features	Source(s)
Classic	Under big toe joint	Inflammation, pain with movement	1,2,6
Traumatic	Thumb, big toe	Linked to injury or overuse	4
Chronic	Big toe, thumb	Persistent, long-term symptoms	4,5
Associated	Big toe, thumb	With fractures/avascular necrosis	2,3

Table 2: Major Types of Sesamoiditis

Classic Sesamoiditis

This is the most common type, usually affecting the sesamoids under the big toe joint (first metatarsophalangeal joint). It is characterized by inflammation due to repetitive stress or biomechanical overload 1,2.

Traumatic Sesamoiditis

Occurring in both the foot and hand, traumatic sesamoiditis is linked directly to an injury, such as a hyperextension or direct blow to the area. This type is especially notable in the thumb following sports or falls 4.

Chronic Sesamoiditis

If not addressed, sesamoiditis can become chronic, persisting for months or even years. Chronic cases may involve not only ongoing pain but also changes in surrounding soft tissues or even bone structure, leading to complications such as joint stiffness or persistent inflammation 4,5.

Associated Disorders

Sesamoiditis can co-exist with, or be mistaken for, other conditions:

• Stress fractures: Small cracks in the sesamoid bones due to repetitive load 2.
• Avascular necrosis: Loss of blood supply to the sesamoid, leading to bone death and chronic pain 3.
• Chondromalacia: Softening of the cartilage covering the sesamoids 2.

Overlapping Conditions

• Nonunions: Failure of a fractured sesamoid to heal can mimic or worsen sesamoiditis symptoms 2.
• Symptomatic bipartite sesamoids: Naturally divided sesamoids can become painful and inflamed 3.

Importance of Differential Diagnosis

Distinguishing between these types is critical for effective management, as treatment strategies may differ depending on the underlying pathology 6.

Causes of Sesamoiditis

Understanding what triggers sesamoiditis is crucial for both prevention and effective treatment. The causes are multifaceted, involving both intrinsic (anatomical) and extrinsic (environmental or behavioral) factors.

Cause	Description	Risk Group	Source(s)
Overuse	Repetitive load from sports/activities	Runners, athletes	1,2,3
Trauma	Direct injury or acute force	Sports, accidents	4
Biomechanical	Foot structure, gait abnormalities	Flat feet, high arch	6
Anatomical Variants	Congenital or acquired bone differences	All	1,2

Table 3: Main Causes of Sesamoiditis

Overuse and Repetitive Stress

The most common cause of sesamoiditis, particularly in the foot, is repetitive stress from activities like running, dancing, or jumping. These activities place repeated pressure on the sesamoid bones beneath the big toe, leading to microtrauma and inflammation 1,2,3.

Traumatic Injury

A direct blow, sudden hyperextension (especially in the thumb), or other acute injuries can damage the sesamoid bones or surrounding soft tissues, sparking an inflammatory response 4. Sports such as basketball, gymnastics, and martial arts are common culprits.

Biomechanical and Anatomical Factors

Certain anatomical features can predispose individuals to sesamoiditis:

• Flat feet or high arches: These alter weight distribution across the foot, increasing stress on the sesamoids 6.
• Abnormal gait: Inefficient walking or running patterns can overload the big toe area 6.
• Congenital anomalies: Some people have naturally bipartite (split) sesamoids or variations in bone shape, which can make them more susceptible to injury and inflammation 1,2.

Less Common Causes

• Infection or inflammatory conditions: Though rare, infections or systemic inflammatory diseases can affect the sesamoid bones 1.
• Improper footwear: Shoes with inadequate cushioning or high heels increase forefoot pressure, exacerbating risk 1,2.

Animal Cases

While uncommon in humans, sesamoiditis can also occur in animals, particularly horses, due to similar mechanisms of overuse and repetitive load 5.

Treatment of Sesamoiditis

Treating sesamoiditis requires a tailored approach, considering the severity, underlying cause, and individual patient needs. Early intervention can prevent chronic pain and long-term disability.

Treatment	Approach	Goal	Source(s)
Rest & Immobilization	Reduce activity, use supports	Decrease inflammation	2,5,6
Offloading Devices	Padding, orthotics, footwear changes	Relieve pressure	2,6
Medication	NSAIDs, analgesics	Control pain	5,6
Physical Therapy	Stretching, strengthening exercises	Restore function	6
Advanced Therapies	Radial soundwave therapy	Speed healing	3
Surgery	Sesamoidectomy (removal), fixation	Severe, nonresponsive	2,4

Table 4: Sesamoiditis Treatment Options

Conservative Approaches

Rest and Immobilization

• Initial management often involves rest, avoiding activities that exacerbate symptoms, and sometimes immobilizing the affected joint with a cast or stiff-soled shoe 2,5,6.
• Box rest and cold hydrotherapy are commonly used in veterinary cases, and similar strategies can be adapted for human patients 5.

Offloading and Pressure Redistribution

• Padding and orthotics: Custom or over-the-counter pads and shoe inserts can redistribute pressure away from the sesamoids, providing relief during movement 2,6.
• Footwear modifications: Switching to shoes with better cushioning, wider toe boxes, or rocker soles can significantly reduce stress on the affected area 6.

Medication

• NSAIDs (Nonsteroidal anti-inflammatory drugs): Medications like ibuprofen help control pain and inflammation 5,6.
• Topical treatments: In some cases, local therapy such as cold packs or anti-inflammatory gels may be advised.

Physical Therapy and Rehabilitation

• Range-of-motion and strengthening exercises can facilitate recovery and prevent recurrence by improving joint stability and gait mechanics 6.
• Patient education is critical for long-term management and prevention of future episodes 6.

Advanced Therapies

• Radial soundwave therapy (RSW): Recent studies indicate that RSW can reduce pain and speed return to activity, especially in athletes. Most patients report significant improvement, with some achieving complete relief 3.
• Other modalities: In persistent or chronic cases, additional therapies such as corticosteroid injections may be considered, though their use is less common.

Surgical Intervention

• Sesamoidectomy: Surgical removal of the affected sesamoid bone is reserved for severe, intractable cases or when conservative measures fail. Outcomes are generally favorable, but some risk of joint stiffness or residual pain remains 2,4.
• Fixation or repair: In cases involving fractures or non-unions, surgical stabilization may be necessary 2.

Multidisciplinary and Individualized Care

A holistic, patient-centered approach is essential. Treatment plans should consider personal activity levels, biomechanics, and social factors. Referral to physical therapists, podiatrists, or orthopedic specialists may be necessary for optimal results 6.

Conclusion

Sesamoiditis is a deceptively complex condition that can significantly impact mobility and quality of life if not correctly identified and managed. Here’s a recap of the key points:

• Symptoms include pain, swelling, tenderness, and reduced motion, most often under the big toe or thumb 1,2,4,5,6.
• Types range from classic and traumatic to chronic forms, with overlapping or associated disorders like stress fractures and avascular necrosis 2,3,4.
• Causes are multifactorial, including overuse, trauma, anatomical variations, and biomechanical factors such as abnormal gait or foot structure 1,2,4,6.
• Treatment starts with conservative strategies like rest, offloading, and medication, advancing to newer modalities such as radial soundwave therapy and, in rare cases, surgery 2,3,4,5,6.

Early recognition, individualized care, and a multidisciplinary approach are essential for optimal outcomes in sesamoiditis.