Sesamoiditis is a reasonably common painful inflammation of the two sesamoid bones under the big toe joint in the foot. The cause of sesamoiditis is typically an overuse or overload type problem in a vulnerable foot.
The treating of sesamoiditis involves resting the area to allow the inflammation to settle and using some sort of off-loading over the long term.
Initially, if the symptoms are severe, there needs to be some pain relief after activity with the use of ICE and maybe NSAID medications. Some sort of felt padding is often applied to the foot to keep the pressure off the foot every time it is on the ground. This off-loading padding will go a long way to protect the sesamoid bones and allow healing to start.
Activity levels will also need to be looked at to see if they can be reduced or modified to decrease the amount of load on the foot. If higher heel shoes have been worn, then they should be replaced with lower heeled shoes. Cushioned shoes, such as a good pair of running shoes should be used as much as possible.
After things start to settle, then insoles in the shoes with extra padding and accommodative padding can be used as a longer term treatment to continue the therapy and act as a preventative measure over the long term. This may go as far as being a good pair of custom made foot orthotics.
If this treatment for the sesamoiditis does not help much then there are injection therapies that may be used to “kick start” the healing. Even with this, the use of the protective padding is still advised.
As a last resort, there are surgical options such as a removal of the sesamoid bones that can be done if it does not respond to the standard treatments.
