Sesamoiditis Under Big Toe Sioux City
Sesamoiditis is a pain underneath the big toe. Usually, the pain begins after the patient participates in activities involving pushing off and quickly changing directions or after forced dorsiflexion of the big toe. Either the direct trauma or the strenuous pull of the tendons causes irritation of the sesamoid bones.
The sesamoids are small bones that serve as anchors and pulleys for the big toe flexor muscles. Several big toe muscles attach to these small bones to allow for movement. Sesamoiditis is more common in people who have hallux valgus, repetitively run or walk on hard surfaces, or wear footwear that is too flexible. Sesamoiditis is also common in people who have a history of foot bursitis, chondromalacia, or stress fractures in the feet. It is also common in people with a history of osteoarthritis, rheumatoid arthritis, or gout.
Evaluation for sesamoiditis involves passively flexing or extending the big toe. Pain is increased with dorsiflexion (toe extension) and relieved with plantar flexion. The area around and under the big toe joint is usually tender. There are two sesamoid bones underneath the big toe, and the medial one is the most commonly involved. X-rays may be taken to evaluate the toe and foot for stress fractures, osteochondritis, bipartite sesamoids, or osteoarthritis.
Home and Office Treatment for Sesamoiditis
Goals of treatment are to decrease sesamoid pain and irritation along with excessive stress on the big toe. Taping is an excellent treatment to reduce excessive strain on the toe and sesamoids. The tape can be applied in a particular direction to limit dorsiflexion, which will prevent the pulling on the toe flexor muscles. Donut-shaped padding can be applied to the bottom of the foot in order to cushion the sesamoids and reduce the pressure while walking. Taping is also helpful with turf toe or other toe sprains.
If the shoes were contributing to the development of the condition, wearing less flexible shoes is recommended. Playing on hard surfaces is not recommended until the condition resolves. For people with bunions, it may be helpful to tape the toe to a more neutral position along with limiting dorsiflexion. Surgical intervention for sesamoiditis is rare, but it can be required in some cases.
Office treatments aimed to decrease pain and inflammation with modalities are limited because of the location and size of the big toe. Ultrasound and cold laser treatment can be helpful at decreasing pain and promoting cellular repair.
Certain home, work, or recreational activities make it difficult to completely rest and reduce the daily strain on the big toe. In the end, it is better to take extra time off to rest. Reducing your activities early in treatment will minimize the risk of developing a chronic irritation and sesamoid pain. Mild cases of sesamoiditis should improve within a few weeks. Moderate cases range from weeks to a couple of months. Severe cases of sesamoiditis may require several months of activity modification, taping, padding, and shoe modifications.