Sesamoiditis

This condition is due to arthritic changes of the surface of the sesamoids at their site of articulation with the plantar head of the first metatarsal

• patients complain of pain, generally under the first metatarsal head during weight-bearing, and particularly when walking
  • often a patient will complain of pain under the metatarsal head as the weight is taken aound about 'toe-off'
• a distinct plantar callosity may be detected clinically but will not be the only cause of localised tenderness; also there may be reduction in extension of the first MTP joint
• similar pain may also be due to fracture or hypertrophy of the sesamoid

Treatment:

• insoles with an aperture cut to raise the sesamoid off the bottom of the shoe and thus to afford relief via cushioning of the lesion; simple cushioning such as sorbothane insoles and silicone gels applied to the area can also help
• steroid preparations injected directly into the sesamoid apparatus will also help reduce pain (1)

Reference:

1. Rheumatic Disease in Practice (September 2001). The therapeutic scope of modern podiatry. Issue number 6, Arthritis Research Campaign.