Sesamoiditis
What is it: The sesamoid bones are small bones within the tendonous structures around the great toe. They can get irritated or injured, and this is called sesamoiditis. They can also develop stress fractures or acute fractures.
How does it present: For sesamoiditis or a stress fracture of the sesamoids, the patient usually develops gradually worsening pain around the base of the great toe in the location of the sesamoids. The pain is usually worse with increased activity and weight bearing and may have been preceeded by a change of intensity or frequency of activity, such as dancing or running. An acute fracture is usually associated with abrupt onset of pain.
Common exam findings: Exam findings may include tenderness to palpation of the sesamoid bones. Movement of the great toe in flexion and extension may also be painful.
Tests and treatment: A foot x-ray may be useful to evaluated for a stress or acute fracture. If the diagnosis is uncertain a bone scan or CT scan may be helpful in further identifying fractures. Treatment is generally conservative, but reducing weight bearing activity, with consideration of some immobilization with a removable cast walking boot while ambulating if pain is significant may be necessary. Padding may be placed in shoe wear to cushion the area or a rigid shoe or orthotic may be used to prevent movement of the great toe. After the pain of the sesamoiditis or stress fracture of the sesamoid is resolved, there should be a gradual return to activity. Acute fractures are generally treated with some form of immobilization with a rigid soled shoe or cast.