Sesamoiditis is an inflammation of one or two bones under the 1st metatarsal. The sesamoids are similar to the patella (knee cap). There are 2 sesamoids; one is the medial with the other the lateral. The medial sesamoid is generally most affected. Sesamoiditis occurs secondary to repetitive trauma to this area. This condition is normally seen in athletes and dancers. The type of activities most susceptible are found in catchers in baseball, Latin dancers, and basketball. High heeled shoes and activities where the weight is shifted to the ball of the foot can contribute to the condition. However, it may be seen in anyone.
The general symptoms include increasing pain with increased standing or walking. Normally, this pain gradually worsens. The pain is greatest with dorsiflexion (movement upward) of the great toe with pressure applied under the 1st metatarsal. The sesamoids are within two tendons which attach to the great toe. They slide within two grooves separated by a ridge under the 1st metatarsal. When this area is placed under continuous stress, the bone(s) become inflamed. In some cases, the sesamoid can fracture. This is difficult to identify since 35% of all sesamoids occur naturally as bipartite (two pieces).
X/Rays are useful, but not always conclusive. By taking an X/Ray, the surrounding area may be evaluated for other possible deformities. A specific X/Ray known as a ski jump view isolates the sesamoids on the radiograph. This can further assist in identifying a fractured or inflamed sesamoid. Sesamoiditis may also be associated with Bunions. As the bunion forms, the great toe and sesamoids migrate inward. This inward migration forces the medial sesamoid over the ridge between the two grooves. This in turn makes the medial sesamoid more prominent on the bottom of the foot. It must then bear more weight and stress. Treatment includes anti-inflammatory medication, cortisone injections, orthotics, pads, physical therapy, ice, and a cam-walker. In chronic conditions where conservative care is unsuccessful, the sesamoid may be removed.
