Treatment for sesamoiditis usually does not require surgery. The treatment is often successful, but can be frustrating in how long it takes for symptoms to resolve. First, your foot and ankle orthopaedic surgeon will recommend the following:
- Stop the activity that causes the pain.
- Take acetaminophen or ibuprofen to relieve the pain.
- Rest and ice the sole of your foot. Do not apply ice directly to the skin; use an ice pack or wrap the ice in a towel.
- Wear soft-soled, low-heeled shoes. Stiff-soled shoes also may be comfortable, but be aware that clogs should be avoided as they elevate the heel and put more pressure under the sesamoids.
- Use a felt cushioning pad around the sesamoid to relieve stress.
- Return to activity gradually and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet (e.g., the elliptical machine).
- Tape the big toe so that it remains bent slightly downward.
In rare occasions, a steroid injection may be appropriate. However, the injection should not be made through the thickened fat pad on the bottom of the foot as this can cause loss of the body's normal fatty cushion in this area.
If symptoms persist, you may need to wear a removable short leg-fracture brace or a cast for 4-6 weeks. Sesamoids tend to heal slowly.
If you have broken your sesamoid bone, your foot and ankle orthopaedic surgeon may recommend non-surgical treatments before resorting to surgery. You will need to wear a stiff-soled shoe, a short leg-fracture brace, or possibly a cast, and your surgeon
may tape the joint to limit movement of the big toe. You also may have to wear a J-shaped pad around the area of the sesamoid to relieve pressure as the fracture heals. Other cushioning pads or orthotic devices often are helpful as the fracture heals. Pain relievers such as acetaminophen or ibuprofen may be recommended as well,
but know that it may take several months for the discomfort to subside.
If non-surgical measures do not work, your foot and ankle orthopaedic surgeon may recommend surgery. In this case, your surgeon may be able to repair the sesamoid, but often they will recommend removal of part or all of the sesamoid.
Healing of the sesamoid typically is slow and can take up to six months. The process can be frustrating but is usually successful.
Failure of healing, avascular necrosis, development of arthritis at the joint between the sesamoid and the first metatarsal, and continued pain are the risks associated with sesamoid injuries. If these should develop, excision of part or all of the sesamoid
can usually resolve symptoms.
Contributors/Reviewers: Scott Ellis, MD; Jeff Feinblatt, MD
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