More Big Toe Pain….

OK, it’s not exactly the big toe, but the ball of the foot behind the big toe. There are two small, pea size bones that are located in the tendon that is attached to the big toe. Even those these are tiny bones that are only faintly felt by pressing underneath the ball of the foot, right before the base of the big toe, they have important functions. Sesamoids function to help stabilize the tendon of flexor hallucis brevis muscle, which they are located within. This muscle tendon is crucial for having the proper biomechanics for walking. The big toe even though it is not a big body part is extremely important for having an even gait; with out the big toe functioning properly, falling may become likely. The sesamoids also function to allow the big toe to have a strong push off during walking.  Lastly, these two tiny bones also act as shock absorbers.  However, these sesamoids even though small, may become irritated. Irritation of the sesamoids is called sesamoiditis. Sesamoiditis may be caused due to the following:

  • Congenitally split into two pieces–very common
  • Wearing high heels-This will put additional constant force and weight on the sesamoids.
  • A large bunion-This deformity causes the sesamoids to shift causing mal-alignment, which results in poor biomechanics during walking, leading to an increased load of stress put on the sesamoids.
  • Jumping, running, or dancing-These activities puts a tremendous amount of additional jarring force on the two bones.
  • Osteoporosis-This causes weakening of the bones, which will not allow the sesamoids to act as shock absorbers and instead will be painful due to decreased density of the bones.
  • High arched foot-This results in additional pressure on the two bones.
  • A plantar-flexed first metatarsal-The bone before the big toe is called the first metatarsal if this bone is positioned too far slanted toward the ground (plantar-flexed) an increased amount of pressure and force will be on the two sesamoids.

Sesamoiditis does not happen all of a sudden, but develops slowly over the course of time possibly due to the list of causes above. The symptoms of sesamoiditis include:

  • Pain in the area of the ball of the foot, especially close to the big toe
  • Swelling after activities
  • Constant pain, but it may be relieved by rest if the sesamoiditis is in its beginning stage
  • Pain when walking barefoot
  • Pain with bending the toe upwards
  • Pain with and/or after activities such as jumping, running, or dancing
  • Pain when wearing or after wearing high heel shoes or thin soled shoes

There are a few treatments to try at home to treat sesamoiditis. These include:

  • Rest and ice your foot after activities
  • Massage the ball of the foot, especially near the base of the big toe
  • Take Ibuprofen or aspirin

If these self-treatments provide no relief, there are various treatment options that a podiatrist can provide. Some of these treatment options include:

  • Adding special padding to shoes
  • Custom-made orthoses to minimize the pressure and force on the sesamoids
  • Cortisone injections to reduce the pain and swelling
  • Immobilizing the foot to take pressure off the bones by temporarily wearing a stiff-soled surgical shoe.

In rare cases, if sesamoiditis cannot be treated, surgery may be an option where the bone may need to be removed. Visit Platte Valley Foot and Ankle Clinic for evaluation and treatment of sesamoiditis or pain in the ball of your foot.

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