Sesamoiditis is a specific form of metatarsalgia that affects the big toe joint in the ball of your foot. It can cause pain when you place pressure on the joint, and even make flexing your toe painful or uncomfortable.
Doesn’t sound like a good time to good running… Or is it?
In this article, we answer the question and give some advice about the best ways to deal with this kind of overuse injury.
Let’s have a look at this painful condition and how to handle it if you’re a runner.
What Are Sesamoids?
Sesamoids are small, round bones that are embedded within the tendons—flexor hallucis brevis and flexor hallucis longus—of the first metatarsal bone of your big toes.
The sesamoid bones are about the size of a corn kernel and are positioned in the tendon next to each other under each big toe joint.
These small bones help to reinforce the tendon, support the body’s weight, decrease the amount of stress that’s placed on the tendon, and allow tendons to exert greater forces on the body.
The sesamoid bones act as a “pulley” for the tendon in your foot, and they help to provide leverage during the push-off when you walk, jump or run. They also help to protect your tendon and lift your big toes up.
What Is Sesamoiditis?
Sesamoiditis occurs when the tendon that surrounds the sesamoid bones becomes irritated or inflamed.
You may notice a dull ache in the ball of your foot that gradually gets worse, with the pain increasing to an intense throbbing. As the sesamoiditis becomes more severe, you may find it difficult to bend or straighten your big toe.
The pain in your toe can intensify when you put any weight on your big toe, which can make it difficult to walk comfortably. There may also be swelling or redness around the big toe joint.
Causes of Sesamoiditis
There are several factors that can cause sesamoiditis. But the main cause of sesamoiditis is simply overuse of the tendons that surround the sesamoid bones.
You can develop sesamoiditis if you spend a lot of time on your feet. Most often, it develops when the repeated bending of the joint places the tendon under excessive strain.
Activities that have repetitive movements like running, tennis, baseball, basketball, and other sports of this type all place the tendons under too much strain as the movements transfer your weight to the ball of your foot.
If your toe flexors are tight, this will place the tendons that attach to the sesamoid bones under a lot of stress. This will irritate the tendons, causing inflammation and leading to sesamoiditis.
Wearing shoes that don’t provide enough support for your arch or gait cycle, especially if you overpronate, can place your forefoot under acute pressure. This will cause the tendons to become inflamed and lead to sesamoiditis.
Medical conditions such as osteoarthritis, which cause inflammation in various parts of the foot, can also increase your risk of developing sesamoiditis.
As you get older, the fatty pad in the forefoot and heel start to get thinner—fat pad atrophy. This leaves the sensitive connective tissue and joints exposed to pressure and strain, which can increase your risk of developing sesamoiditis. It can help if you wear inserts for fat pad atrophy.
How Do I Test the Tightness in My Toe Flexors?
To test the tightness of your toe flexors, start by sitting with your legs extended out in front of you, ideally with your ankle hanging over the edge of the bed or chair. Test your toe by seeing if you’re able to bend it upwards.
With your foot pointed down, there should be an extension of at least 60 degrees in the big toe joint when you bend the toes backwards. Then with your toes pointed towards the ceiling, bend your big toe towards you. The range of motion in your big toe should be the same.
It’s important to note that you should not be bending your toe using your hand. You should be bending it using your toe flexor tendons only.
Can Running Cause Sesamoiditis?
Yes, running can cause sesamoiditis. The repetitive motion of running can put your tendons under an excessive load, which leads to sesamoiditis.
You may be at a higher risk of developing sesamoiditis if you’ve rapidly increased your running mileage, training intensity, hill repeats or hill intervals, or speed work.
Unlike muscles, which can adapt and gain strength quickly, the bones, ligaments, and tendons don’t strengthen nearly as quickly. This can lead to inflammation or tiny tears in the tendons, which can cause sesamoiditis.
If you continue to run while you’re suffering from the effects of sesamoiditis, this will aggravate the sesamoid bones and the condition will worsen.
How Should Runners Treat Sesamoiditis?
If you’re experiencing any of the symptoms of sesamoiditis, the best way to treat it is to rest your foot. This may mean that you have to stop running until the pain and inflammation has subsided.
You can also apply ice to the affected foot for 10 to 20 minutes several times a day to alleviate the pain and reduce the inflammation.
Elevate your foot while sitting or lying down by using pillows, so that your foot is above your heart level. This will help to reduce the swelling and is also an excellent time to apply ice.
You can also use over-the-counter nonsteroidal anti-inflammatory drugs to help manage the pain and reduce inflammation.
The symptoms of sesamoiditis take between 4 and 6 weeks to heal if you rest your foot and take steps to reduce the inflammation. However, if the symptoms get worse or don’t go away after a few weeks of resting, you should go and see your podiatrist.
It’s best to treat sesamoiditis as soon as you experience any symptoms. If you leave it too long, the condition can become severe. This can lead to chronic pain, possibly a fractured or broken sesamoid bone, and may even require surgery.
Simple Lifestyle Changes Help: Treatments You Can Do Yourself
Fortunately, there are steps that you can take that can help prevent sesamoiditis from recurring.
Protect your feet by using a pad for sesamoiditis – sometimes called a dancer’s pad – to reduce the pressure that’s placed on the bones. It will also absorb shock as you go about your daily activities.
Make sure that you’re wearing shoes for sesamoiditis that provide the right amount of support for your feet. The shoes should have a spacious toe box, shock-absorbing cushioning, appropriate arch support for your feet, and the outsole should be stiff.
You can use over-the-counter insoles to reduce the pressure that’s placed on the ball of your foot. Insoles will add an extra layer of cushioning, which can protect your feet from the shock of impact.
To limit the movement of the big toe joint, you can try taping your big toe. This will help reduce the load and amount of strain that’s placed on the tendons, allowing your toe to heal more quickly.
Make sure to start slowly and gradually increase your mileage and intensity when you return to running. If you do happen to feel any pain after a run or other activities, then follow the R.I.C.E principle—rest, ice, compression, and elevation.
What Is a Sesamoid Stress Fracture?
A sesamoid stress fracture is when a hairline crack—incomplete break—forms in one or both of the sesamoid bones.
These fractures are most often caused by repeated stress that’s placed on the bones, which happens by rapidly increasing running distance, intensity, hill intervals, or speed work before your body is ready for it.
To diagnose a stress fracture in your sesamoid bones, your podiatrist will examine your big toe by moving it and they may even analyze your walking pattern.
But the most telling diagnosis tool will be an MRI scan. Fortunately, a stress fracture can be seen on a MRI even when it’s in its earliest stages.
When to Consider Surgery
In most cases, you can treat sesamoiditis easily and effectively with some lifestyle changes, orthotics that conform to your feet, and anti-inflammatory medication.
Surgery is often only considered as an option if the fractured sesamoid bone has moved apart, if you’re in chronic pain—also known as sick-sesamoid-syndrome—or when the sesamoid bone is severely arthritic.