From the Guidelines
Treatment for sesamoiditis typically begins with conservative measures including rest, ice, and anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation. The most recent and highest quality study that provides guidance on the treatment of sesamoiditis is not directly available in the provided evidence. However, based on general medical knowledge and the principles of treating similar conditions, the initial approach to managing sesamoiditis involves reducing inflammation and alleviating pressure on the affected area.
- Conservative measures are the first line of treatment, aiming to reduce pain and inflammation.
- Padding the area with felt or gel cushions can help reduce pressure on the sesamoid bones.
- Wearing shoes with a stiff sole, low heel, and wide toe box is recommended to minimize movement of the affected joint.
- Taping or strapping the big toe can immobilize the joint and reduce pain.
- Physical therapy exercises to strengthen foot muscles and improve flexibility may be prescribed after acute pain subsides.
- For persistent cases, a walking boot or short leg cast might be used for 4-6 weeks to completely rest the area.
- Corticosteroid injections can provide temporary relief for severe inflammation.
- Surgery is rarely needed but may be considered if conservative treatments fail after 6-12 months 1. Sesamoiditis occurs when the sesamoid bones under the first metatarsal become inflamed due to repetitive pressure or acute trauma, commonly affecting dancers, runners, and those wearing high heels frequently. Given the nature of the provided evidence, which largely pertains to skin and soft tissue infections, and the specific question about sesamoiditis, the guidance from the American College of Foot and Ankle Surgeons, as mentioned in the study from 2002 1, is most relevant. This approach prioritizes conservative management to address morbidity, mortality, and quality of life outcomes for patients with sesamoiditis.
From the Research
Treatment Options for Sesamoiditis
- Conservative management: This includes temporary padding/strapping, education, footwear, and foot orthoses 2
- Intra-articular injections: Methylprednisolone and bupivacaine have been used to treat sesamoid disease in dogs, with 89.7% of dogs demonstrating resolution of lameness one week after treatment 3
- Immobilization: Immobilization boots and analgesic and anti-inflammatory drugs may be prescribed, but may not be effective in all cases 4
- Steroid injections: Steroid injections into the subsesamoid joint have been shown to be an effective treatment for chronic sesamoiditis, with long-lasting results 5
- Sesamoidectomy: This is a surgical procedure that involves removing the affected sesamoid bone, and is typically reserved for cases where conservative management has failed 5, 6
Special Considerations
- Systemic disease: Sesamoiditis can be a manifestation of systemic disease, such as gout, and a thorough investigation should be conducted to rule out underlying conditions 4
- Comorbidities: Sesamoid disease in dogs has been found to often occur in conjunction with other comorbidities, such as elbow disease 3