This book describes Sesamoiditis, Diagnosis and Treatment and Related Diseases
Sesamoiditis is the inflammation of the Sesamoid bones.
The sesamoids are small bones that are not connected to any other bone.
Instead, they are joined only to tendons or are embedded in muscle.
The kneecap (patella) is the biggest sesamoid bone in the body.
Sesamoids function like pulleys.
They supply a smooth surface over which the tendons slide, thus raising the ability of the tendons to transmit muscle forces.
The sesamoids in the forefoot also help with weight bearing and raise the bones of the big toe.
Similar to other bones, sesamoids can break (fracture).
Also, the tendons enclosing the sesamoids can become irritated or inflamed.
This is called sesamoiditis and is a type of tendinitis.
It is frequent among ballet dancers, runners and baseball catchers.
Cause
Sesamoiditis is normally produced by overuse of the foot in a plantar flexed position.
Cleats with little insole padding can direct excess stress on the 1st MTP or sesamoid and thus can activate this condition.
A depressed first bone, forefoot valgus, or pes cavus deformity can cause sesamoiditis as well.
1. Turf toe is produced by hyperextension of the first MTP joint beyond the normal 60° of dorsiflexion.
The incidence of the injury has risen with the widespread use of artificial surfaces.
Lightweight, poorly supported, flexible shoes can make the athlete prone to injury.
2. Sever disease is produced by excessive traction on the calcaneal apophysis by the Achilles tendon, particularly during running and jumping.
Inflexibility of the gastrocnemius, hamstring, quadriceps, and hip flexor muscles can aggravate this disorder.
3. Posterior tibial tendinitis is produced by repetitive trauma during the pronation phase of cutting, jumping, or running.
4. Pes planus is a risk factor.
5. Peroneal tendon subluxation/dislocation most often happens with powerful contraction of the peroneal muscles, normally in maximal dorsiflexion.
Symptoms
Pain is directed under the big toe on the ball of the foot.
With sesamoiditis, pain may form slowly; with a fracture, pain will be iinstant.
1. Painful/aching on walking.
2. Local tenderness to palpation.
3. Limitation of first MTP motion.
The joint may be painful on dorsiflexion against resistance.
4. Thickening or inflammation of a bursa on the plantar surface
5. Peroneal tendonitis may develop due to changes in gait from the pain.
6. Swelling and bruising may or may not be present.
7. The patient may have difficulty and pain in bending and straightening the big toe.
Diagnosis
During the examination, the doctor will examine for tenderness at the sesamoid bones.
Since the edges of a bipartite medial sesamoid are normally smooth, and the edges of a fractured sesamoid are normally jagged, an X-ray is useful in making a proper diagnosis.
The doctor may also order X-rays of the other foot to compare the bone structure.
If the X-rays seem normal, the doctor may order a bone scan.
Treatment
Treatment is normally non-operative.
If conservative measures fail, the doctor may advise surgery to remove the sesamoid bone.
Sesamoiditis
1. Stop the activity causing the pain.
2. Take aspirin or ibuprofen to relieve the pain.
3. Rest and ice the sole of the feet.
4. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
5. Wear soft-soled, low-heeled shoes.
6. Use a felt cushioning pad to relieve stress.
7. Return to activity slowly, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them.
8. Avoid activities that put the weight on the balls of the feet
9. Tape the big toe so that it remains bent slightly downward
TABLE OF CONTENT
Introduction
Chapter 1 Sesamoiditis
Chapter 2 Causes