Pain Under the Big Toe Joint: Sesamoiditis

sesamoid pain

Pain under the big toe joint can be a significant nuisance, and can make walking, squatting, and jumping painful.  This pain is typically due to a common condition called sesamoiditis.  Sesamoiditis is inflammation of one of two small, egg-shaped bones found under the big toe joint., known as the sesamoid bones.  Every human has them, although some can have sesamoid bones that form in two or three separate pieces.  They provide an assisting role in bearing weight across the big toe joint and stabilizing certain tissue structures around the joint.

Injury to the sesamoids can immediately occur when falling onto the ball of the foot, directly kicking an object that forces the big toe upwards, or a direct crushing blow to the bottom of the foot.  The sesamoid bones can also become injured over a longer period of time when there is repetitive pressure on the ball of the foot from activities such as dancing, as well as during repetitive work-related activities, like pedal use in machinery or platform standing.

Symptoms of sesamoiditis can include a sharp pain or dull ache on the bottom of the big toe joint.  This pain becomes worsened when the toe is flexed in an upwards direction. Any activity that stresses this joint, including walking, running, and jumping, can cause pain.  This is especially true while one is barefoot. The use of supportive flat shoes tends to decrease the pain, while the use of high heeled shoes magnifies the pain. The tissue under the big toe joint may feel swollen or full, and may even be warm to the touch in less common cases.

Sesamoiditis is diagnosed by a simple foot exam, although x-rays and sometimes MRI is used to rule out a more significant injury like a fracture or stress fracture.

Sesamoiditis is treated with anti-inflammatory medicine, either taken orally or injected in the form of a steroid compound (provided no stress fracture is suspected). The big toe joint is supported with padding or specialized inserts to reduce pressure underneath, or by modifying the activity that caused sesamoiditis in the first place.  The use of stiffer-soled shoes is also helpful.  More serious cases may require immobilization in a walking boot or in a cast for up to several months.  Cases that simply won’t heal with any of these measures may require surgical intervention.  Surgical removal of one of the sesamoids is typically effective at eliminating the pain, and is sometimes also necessary when stress fractures or true fractures won’t heal.

While sesamoiditis only involves one small part of the foot, it nonetheless can be very painful and can limit both athletes and simply active people in a significant way.  Fortunately, it can be treated, but the road to recovery can be long if not treated early on and with all the necessary measures to address both the inflammation as well as the underlying cause of this condition.

The Annoying Metatarsal Stress Fracture

metatarsal pain

Metatarsal stress fractures are a common foot injury that can be quite a nuisance to heal.  The metatarsals are the five long bones in the foot that form a bridge between the toes and the middle of the foot.  These roughly drumstick-shaped bones are fairly sturdy, but can be fractured during twisting injuries, or something heavy smashing down upon the top of the foot.  These fractures are treated with either immobilization in a walking boot, or surgery if the bones are out of place or unstable.  This treatment is straight forward, and is successful usually in a fairly set amount of time.

A stress fracture is something entirely different.  Stress fractures occur when bone is subjected to long term low grade stress and strain that slowly causes internal damage to its interior.  These stresses can be common place activities like steeping off of platforms at work, or lever and pedal use.  Even the position of the foot on a cross bar under a desk can put strain on the metatarsal.  Poorly supportive shoes can magnify the risk of bone injury, and some people are even at greater risk for a stress fracture because of issues with the quality of their bones.

Stress fractures can have multiple symptoms, ranging from a dull ache in the middle of the foot to a sharp pain while standing and walking.  Stress fractures can occur in many places along the metatarsal length, and can sometimes occur in several bones at once.

The treatment of metatarsal stress fractures is a little trickier than treating a regular fracture.  In most instances, surgery is neither necessary nor helpful.  Immobilization in either a walking boot, or less commonly a cast, is needed to reduce stress to the bone and allow it to heal.  A stiff soled shoe can be used for support in a small number of mild cases for relief.  Most metatarsal stress fractures take anywhere from one to three months to heal, and sometimes take longer.  The bone simply needs time to mend, although in some cases an electronic bone stimulator can be used in cases that refuse to heal.   The amount of time one must wait can be frustrating for people trying to get active again.  It can be even more frustrating for athletes trying to get back to their sports.  Fortunately, these stress fractures do eventually heal, and stay healed for the most part.