We often think of our bones as being entirely connected in one full skeletal system, but did you know that we have some bones that aren’t attached to any others at all? These bones, called sesamoids, are instead connected only to tendons or exist in muscle. You only have to look at your kneecap to see the largest sesamoid you have, but there are also two much smaller ones in the underside of your foot. Unfortunately, being small doesn’t mean they can’t cause big foot pain. If these bones cause inflammation or discomfort, it is often known as sesamoiditis.
What Are These Little Bones For, Anyway?
The two sesamoids in the foot are located in the underside of the forefoot around the area of the big toe. One is located more toward the outer side of the foot and the other more toward the middle. These bones assist the foot in bearing and distributing weight, as well as provide a nice, smooth surface for the tendons to slide and transmit force.
Given the sesamoids’ positions around all this weight and pressure, there is opportunity for things to go wrong. These small bones can fracture, or the surrounding tendons can become inflamed and sensitive. Pain from sesamoiditis is typically felt just under the big toe, in the ball of the foot. If a fracture is to blame, this pain will happen in a flash. If inflammation is the cause, this pain tends to come on more gradually. There may also be swelling or bruising around the ball of the foot, or it might become more difficult to bend and straighten the big toe, but these symptoms do not always occur.
Caring for the Little Guys
If sesamoiditis is a suspected cause of forefoot pain, our doctors here at Martin Foot and Ankle will search for a tender feeling in your forefoot. We may ask you about your history of activity, as well as ask you to try and bend or straighten your big toe, or try and gently bend it upward. An x-ray of the forefoot might also be needed to confirm or rule out the possibility of a sesamoid fracture.
Whether the source of the foot pain is inflammation or fracture, conservative treatments are often all that is needed for recovery. If inflammation is to blame, rest and ice therapy will usually be recommended. You may also have to stop any activities that may have caused the condition to begin with, such as running or dancing, until things fully heal. The big toe might be taped at a downward angle and a change of shoes or cushioning inserts may be recommended to help relieve stress. Once cleared, a gradual return to activity can be made.
In case of a fracture, the toe joint may need to be taped to limit motion, and a stiff-soled shoe or brace might also need to be worn. Cushioning pads, including special J-shaped pads, can also help provide support and cushioning. Whereas inflammation tends to heal after about 6 weeks, full healing from a fracture may take several months.