From the Research
Sesamoiditis in pediatric patients should be treated with conservative measures, including rest, ice application, and activity modification, as well as non-steroidal anti-inflammatory medications such as ibuprofen or naproxen, with a focus on reducing pressure on the forefoot and promoting healing. The symptoms of sesamoiditis in pediatric patients typically include pain and inflammation in the forefoot, particularly beneath the first metatarsal head, which can be exacerbated by activities involving forefoot loading such as ballet, basketball, or running 1. Treatment options for sesamoiditis in pediatric patients include:
- Conservative measures such as rest, ice application for 15-20 minutes several times daily, and activity modification to reduce pressure on the forefoot
- Non-steroidal anti-inflammatory medications such as ibuprofen (10mg/kg/dose every 6-8 hours, not exceeding 40mg/kg/day) or naproxen (5-7mg/kg every 8-12 hours) to manage pain and inflammation
- Footwear modifications, including shoes with a wide toe box and low heels, possibly with cushioned insoles or orthotic devices featuring a cutout beneath the sesamoids to offload pressure
- Physical therapy focusing on gentle stretching of the plantar fascia and strengthening of intrinsic foot muscles
- For persistent cases, a short period (2-3 weeks) in a walking boot or the use of padding techniques like felt or foam donut pads around the sesamoids can provide relief Most pediatric cases resolve with these conservative approaches within 4-6 weeks, and surgery is rarely needed in children but may be considered for cases resistant to conservative treatment for 6+ months 2. It is essential to note that the treatment of sesamoiditis in pediatric patients should prioritize reducing morbidity, mortality, and improving quality of life, and the most recent and highest quality study should be considered when making a definitive recommendation 3. In the context of real-life clinical medicine, a firm decision on the side of caution should be made when the evidence is not very strong or equivocal and mixed, prioritizing the well-being and safety of the pediatric patient 4. The use of anti-inflammatory medications, such as NSAIDs, can be beneficial in reducing pain and inflammation, but their use should be carefully considered and monitored in pediatric patients 5. Overall, a comprehensive treatment approach that incorporates conservative measures, medication, and lifestyle modifications can help manage sesamoiditis in pediatric patients and promote optimal outcomes.