From the Guidelines
Sesamoiditis should be treated with initial options including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) to reduce pressure on the area and alleviate symptoms. The diagnosis of sesamoiditis involves identifying inflammation of the sesamoid bones, which are small bones embedded in tendons under the big toe joint. Treatment options, as recommended by the American College of Foot and Ankle Surgeons 1, focus on reducing pressure on the affected area and managing symptoms. Key treatment strategies include:
- Wearing open-backed shoes to reduce pressure on the area
- Using heel lifts or orthoses to support the foot
- Taking NSAIDs to reduce pain and inflammation
- Decreasing activity to avoid exacerbating the condition
- Performing stretching exercises to improve flexibility and reduce stress on the sesamoid bones
- Losing weight, if indicated, to reduce pressure on the foot It is essential to note that local injections of corticosteroids are not recommended 1, and immobilization may be considered in acute or refractory cases. If improvement occurs within six to eight weeks, treatments are continued until symptoms resolve 1. In real-life clinical practice, it is crucial to prioritize conservative management approaches, given the potential risks associated with more invasive treatments, such as corticosteroid injections or surgery.
From the Research
Diagnosis of Sesamoiditis
- Sesamoiditis can be diagnosed through imaging tests such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan, which play an important role in narrowing down the differentials and guiding appropriate therapy 2
- The condition can present as chronic great toe pain and may be overlooked or misdiagnosed for other pathologies 2
- Sesamoid bones have been seen with periostitis in Reiter's syndrome, and the medial sesamoid bone of the thumb metacarpophalangeal is frequently enlarged in acromegaly 3
Treatment of Sesamoiditis
- The treatment of disabling pain in a sesamoid bone is enucleation of the bone 3
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain, including sesamoiditis 4
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries, including sesamoiditis 4
- Acetaminophen is also a well-tolerated option for managing pain, but lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 4
- In some cases, medications that work on opioid and monoamine receptors, such as tramadol or tapentadol, may be used for severe or refractory acute pain, but with caution due to the risks associated with opioid medications 4