From the Guidelines
Sesamoiditis should be initially treated with rest, NSAIDs, and orthoses to reduce pressure on the affected area. This approach is based on the recommendations from the American College of Foot and Ankle Surgeons, as reported in the American Family Physician journal 1. The treatment options may include open-backed shoes, heel lifts, decreased activity, stretching exercises, and weight loss if indicated.
Some key considerations for managing sesamoiditis include:
- Avoiding activities that worsen pain
- Applying ice to the affected area for 15-20 minutes several times daily to reduce inflammation
- Taking NSAIDs like ibuprofen or naproxen to manage pain and swelling
- Wearing shoes with a wide toe box and low heels to reduce pressure on the sesamoids
- Using cushioned insoles or orthotic devices with a cutout to relieve pressure on the sesamoid bones
It's essential to note that local injections of corticosteroids are not recommended as an initial treatment option, according to the study 1. However, in particularly acute or refractory cases, immobilization may be considered. If improvement occurs within six to eight weeks, treatments are continued until symptoms resolve.
In terms of specific treatment protocols, the study 1 suggests that initial treatment options should focus on reducing pressure on the affected area and managing pain and inflammation. By following this approach, patients with sesamoiditis can expect to see improvement in their symptoms and can work towards full recovery.
From the Research
Definition and Assessment of Sesamoiditis
- Sesamoiditis is a common and often painful musculoskeletal pathology frequently encountered by podiatrists 2
- There are currently no recommendations to guide podiatrists in the assessment and management of people with sesamoiditis, but a recent study has developed consensus-driven clinical recommendations on the assessment and management of people with sesamoiditis 2
- The assessment of sesamoiditis includes subjective assessment (pain characteristics/symptomology, activity/sports/training history, and medical history) and objective assessment (establishing a diagnosis, identifying contributing biomechanical factors, footwear/orthoses, ruling out differential diagnoses) 2
Management of Sesamoiditis
- The management of sesamoiditis includes temporary padding/strapping, education, footwear, foot orthoses, and when to consider referral 2
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to treat pain and inflammation associated with sesamoiditis, but their use should be guided by current evidence and clinical practice guidelines 3, 4, 5, 6
- Intra-articular NSAID injections may be an alternative therapy for treating osteoarthritis-related pain, including sesamoiditis, with a potentially lower risk of systemic side effects 4
Safety and Efficacy of NSAIDs
- The efficacy of NSAIDs against inflammation, pain, and fever has been well established, but their long-term use is associated with a high incidence of adverse events, particularly in the gastrointestinal tract 3
- The safety profile of NSAIDs varies depending on the specific medication, with celecoxib appearing to have a lower risk of major toxicity compared to ibuprofen and naproxen 6
- The optimal use of NSAIDs in the treatment of sesamoiditis and other musculoskeletal conditions requires careful consideration of the potential benefits and risks, as well as alternative therapies and management strategies 2, 5