Sesamoiditis

If it feels like you have a stone bruise under the ball of your foot, it could be Sesamoiditis.

What is Sesamoiditis?

The sesamoid bones are two spherical shaped bones that sit under the head of the 1st metatarsal bone (long bone). This is often called ‘the ball of the foot’. Sesamoiditis, is inflammation of these spherical bones and the soft tissues that surround them.

What does the pain feel like?Sesamoiditis Diagram

People describe the pain as a ‘stone bruise’ sensation under the ball of the foot.  Most people who present with this condition have a biomechanical (structural and functional) foot problem which results in a larger than usual amount of ground pressure focussed up under the sesamoid bones. If you have a cavoid (very high arch) foot type then you have a much higher than normal chance of developing this condition.

Left untreated, the little bones are prone to stress fracture and ongoing problems.

Who gets Sesamoiditis?

People with a cavoid (high arch) foot type who spend long period of the day standing and/or who run or exercise, are more likely to develop this condition

At Balance Podiatry, our podiatrists see this condition predominately in people over 18 who are active and on their feet at work. People with a cavoid (high arch) foot type who spend long period of the day standing and/or who run or exercise, are more likely to develop this condition. Also, as we age the fat pad under the ball of the foot will tend to thin, resulting in more pressure and less cushioning under the

How we treat Sesamoiditis?

To diagnose the problem, our podiatrists will take a detailed history, perform a physical assessment, use video walking analysis and take a 3D foot scan to find out what’s causing the pain.

Following thorough assessment and diagnosis, our podiatrists will usually prescribe a highly customised and modified orthotic device. We find our custom-made orthotics are extremely effective in treating this condition.

Conservative

Treatment will vary between patients and will typically involve a period of rest from any activities likely to aggravate the problem. Immobilization strapping, ice and oral anti-inflammatory drugs may also be utilized to settle inflammation and pain and aid in the healing process. A soft full length functional orthotic is commonly used to offload the sesamoids and deflect pressure away from the painful area. Orthotics are essential in treating an underlying causative foot condition, such as flat feet (pes planus), high arched feet (pes cavus), bunions or those with reduced plantar fatty padding. In the case of persistent severe sesamoiditis or stress fractures of the sesamoids, the use of short leg Pneumatic walker with rocker sole (walking cast) for 2 to 6 weeks may be required. Failing this an injection of steroids or surgery may be considered.

Surgery
In severe cases or following a true fracture of the sesamoids, surgery may be required to remove the damaged or fragmented sesamoid bone. Also in some cases, due to reduced blood supply there may be delayed or absent healing and a surgical review is warranted.

Expected Outcome

Most individuals will have immediate improvement is symptoms with conservative care, with total resolution achieved within months. Ongoing management may be recommended in those with an underlying foot condition.