Sesamoiditis: A guide for patients

The sesamoids bones of the big toe joint sit underneath the metatarsal head and do a number of things, such as protecting the joint and increasing the effectiveness of one of the tendons/muscles, which inserts into the base of the big toe bone on the underside of the foot.

As they are in a prominent position on the underside of the big toe joint, they can be susceptible to injury. Often the injury is just associated with overuse and not associated with conditions, such as a fracture or interruption of the blood supply to the bone. When there is no specific cause, the umbrella term of sesamoiditis is used. Sesamoid injuries account for 12 per cent of big toe complex injuries and four per cent of all foot and ankle injuries.

Often, patients can recall a traumatic event or a time when they have either gone for a longer walk than normal or increased their sporting activity.

In these cases, the problem is often resolved by a period of limited weight-bearing in a rigid soled shoe, such as a running or walking trainer. If a patient is experiencing severe pain, a period of non-weight-bearing or an aircast boot may be recommended. After a period of reduced activity or immobilisation, an insole manufactured by the podiatry service can help with recovery and preventing the problem from recurring.

The podiatric surgeon may give a steroid injection into the space around the sesamoids.

In some cases, the problem can be related to a fracture of the sesamoid bones or due to interruption of its blood supply; this weakens the bone and can cause it to collapse and become arthritic.

With both of these, a period of non or partial weight-bearing, in an aircast boot, is recommended. This allows the bone to heal and should reduce the need for any surgical management.

If the problem persists, surgical management may be necessary. This includes repairing soft tissue structures around and encompassing the sesamoids, as well as cutting out the problem sesamoid.

Investigations for this condition include x-rays, ultrasound and MRI.

Recovery after your operation

After this procedure, you will be in a non-weight-bearing cast for up to eight weeks.

The first two days

• You will be in a heel walker for the first three weeks. This shoe only allows you to bear weight on the heel.
• You must rest, with your feet up, as much as possible. Restrict your walking to bathroom visits only.
• Pain is usually worse for the first two days. If you experience pain, take the prescribed painkillers. If you are still experiencing pain after three to four days that is not relieved by the painkillers, get in touch with us.
• If you have any concerns about your foot, please contact us.
• Outside of normal working hours, please contact your GP or go to your local A&E department.

One to two weeks after surgery

• The wound will be checked and the foot re-dressed.

Three weeks after the surgery

• The stitches will be removed and a light dressing will be placed over the wound.
• You will be advised to return to a lace-up pair of running trainers. It is important that these trainers have a thick sole.
• You will experience discomfort from the surgical site. This can last up to 10 weeks following the operation. This is not unusual.
• Depending on the type of work you do, you should be able to start returning to work. If your work involves being on your feet for an extended period of time, a longer rest period is necessary. This will be discussed with you by the podiatric surgeon.

Ten weeks after the surgery

• You should be able to return to more high-impact activities.

Six months after the surgery

• All healing should be complete.

Frequent or serious risks

All operations carry a small risk of complications. In foot surgery, complications are uncommon and most resolve without permanent disability or pain. General and specific complications of this procedure include:

• infection (two in 100)
• delayed healing of the skin (eight in 100)
• non-compliance of patients (four in 100)
• prolonged swelling post operatively (four in 100)
• thick or sensitive scar formation (four in 100)
• blood clot deep vein thrombosis (DVT)
• if both sesamoids have been removed, over time the big toe may become slightly hammered if the sesamoids on the inside of the big toe joint have been removed, a slight bunion deformity may develop
• if the sesamoids on the outside of the big toe joint have been removed, the big toe may deviate towards the inside of the foot.

Complications following foot surgery are rare, but can happen. If there are complications, you will be need to visit the hospital more frequently and there could be significant impact on the time it takes you to recover and return to work. Foot surgery should be avoided if it is only for cosmetic gain.