The sesamoids are two bones of the foot that are commonly poorly understood. They are often not even considered in the count, but can produce a chronic pain to the ball of the foot that is very limiting. Since the pain is quite problematic, it has produced a condition called "Sick Sesamoid Syndrome" which can include everything from an acute sesamoiditis, sesamoid fractures or just pain. The pain is what we will commonly give this designation and treat as such.
Chronic Pain Treatments
So you have Sick Sesamoid Syndrome and the pain isn't resolving with the usual treatments of casting (cast or removable boot), splinting, padding (by an adjustment to the insole to remove all the weight from under the great toe) or even cortisone shots to the sesamoid joint. In fact, the pain seems to continue to increase and is aggravated from any activities, including the simple act of walking. So what treatment options are available?
- Offweighting Insole: This treatment is really a continuation of the previous treatments and is designed to reduce but not necessarily resolve the pain. The area of the insole under the great toe is removed to spread the weight to the other metatarsals and remove all weight from under the sesamoid apparatus.
- Cortisone Shots: Usually a temporary treatment of the chronic pain, and will often only provide 4-6 weeks of relief. The cortisone has associated side effects including possible weakening of the tendons in the area and thinning of the fat pad, but may provide some mild relief. This is often not the recommended treatment option.
- Surgical Correction: Surgical removal of the symptomatic sesamoid (or both sesamoids) can be done. Although the sesamoids do have a purpose (they function as the knee cap of the great toe, protecting the associated tendons), they can be removed if done correctly and allow quicker return to regular activities. We recommend this option primarily if the pain won't resolve with other treatments.