What is the diagnosis and treatment for sesamoiditis?

From the Guidelines

Sesamoiditis should be treated with rest, ice, and non-weight bearing activities for 4-6 weeks, along with over-the-counter anti-inflammatory medications like ibuprofen or naproxen to reduce pain and inflammation, as this approach has been shown to be effective in managing the condition and improving quality of life 1.

Diagnosis and Treatment

Sesamoiditis is inflammation of the sesamoid bones, small bones embedded in tendons under the big toe joint. The diagnosis of sesamoiditis can be challenging, but radiographs are usually performed initially to evaluate the first metatarsal sesamoids and may be useful to diagnose sesamoid dislocation and osteoarthritis, or to distinguish between bipartite versus fractured sesamoid 1.

Key Considerations

• Padding the area with felt or gel cushions can help offload pressure.
• Wear shoes with a wide toe box and low heels, and consider custom orthotics with a depression for the sesamoid bones.
• Physical therapy focusing on toe and foot strengthening exercises may be beneficial once acute pain subsides.
• For persistent cases, a walking boot or short leg cast might be necessary for 2-4 weeks, followed by gradual return to activities.
• Corticosteroid injections are sometimes used for severe inflammation, though sparingly due to risk of tendon weakening, and local injections of corticosteroids are not recommended as initial treatment options 1.

Important Notes

• Sesamoiditis occurs because these small bones bear significant weight during walking and can become irritated from repetitive pressure, especially in activities like dancing, running, or those requiring frequent toe-bending.
• Surgery is rarely needed but may be considered if conservative measures fail after 6 months.
• It is essential to prioritize morbidity, mortality, and quality of life when managing sesamoiditis, and the treatment approach should be tailored to the individual patient's needs and circumstances 1.

From the Research

Diagnosis of Sesamoiditis

• Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ) 2
• Diagnosis is based on a combination of patient history, physical examination, and ruling out differential diagnoses 2, 3
• Assessment approaches used in the diagnosis of sesamoiditis include:
  • Obtaining a patient history 2
  • Recreating patient symptoms 2
  • Determining contributing biomechanical factors 2
  • Ruling out differential diagnoses 2, 3
• Objective assessment includes establishing a diagnosis, identifying contributing biomechanical factors, and evaluating footwear and orthoses 3

Treatment of Sesamoiditis

• Treatment options for sesamoiditis include:
  • Conservative management, such as cushioning of the sesamoids, pressure redistribution, and immobilization of the 1MTPJ 2
  • Patient education and consideration of patient factors, such as symptomology and lower limb biomechanics 2, 3
  • Footwear and orthoses modifications 3
  • Referral to other health professionals for further treatment or management 2
• Surgical options, such as sesamoidectomy, may be considered in cases of failed conservative management 4, 5
• Sesamoidectomy has been shown to be a safe and viable procedure for patients with sesamoiditis who fail conservative measures, with resolution of symptoms in all 12 patients in one study 4
• Other treatment options, such as steroid injections, have also been shown to be effective in managing chronic sesamoiditis, with long-lasting results in some cases 5