Pain on the undersurface of the great toe can limit function of the forefoot with walking, physical activity and sports. Early detection and treatment of sesamoiditis is essential to allow for healing and return of normal function. Fracture of the sesamoid bones can change normal mechanics of the foot and limit normal mechanics. This has serious consequences in sports and physical activity. http://bauerpt.com

1. Sesamoiditis
Atanasia Barabas
Chapman University, DPT 2015
Student Physical Therapist, Bauer PT

2. Anatomy
● 2 sesamoid bones in the tendon of the flexor hallucis
near the 1st MTP joint
● Function to:
● to increase the mechanical advantage of the flexor
hallucis longus and brevis and increase plantarflexion
strength at the 1st MTP joint
● Disperse forces to the medial forefoot

3. Pathology
● Inflammation of the FHL tendon surrounding the
sesamoid bones due to overuse and repetitive stress
● Causes can be structural, such as pes cavus foot type,
and/or mechanical in nature

4. Symptoms
• Results in pain with weight bearing on the
forefoot
• Gradual onset of pain, worsened with
increasing activity
• Aggravating factors include wearing high
heels, jumping, running, stairs, and
dancing
• Symptoms are alleviated with rest, ice,
and non-weight bearing positions

5. Considerations for Treatment
● First ray position and mobility
● Rear foot alignment and mobility
● Forefoot alignment
● Dorsiflexion range of motion
● Demand placed on the foot in ADLs or sports
● Current stage of healing

6. Clinical Findings
● Common findings for individuals with this pathology
include:
● Loss of ROM at 1st MTP joint
● Decreased plantarflexion and dorsiflexion strength of
great toe
● Painful static test
● Tenderness to palpation on of the 1st MT head on the
plantar aspect
● Decreased weight bearing ability due to pain

7. Differential Diagnosis
● Bursitis
● Chrondromalacia
● Tenosynovitis of the FHL
● Sesamoid fracture
● MRI and X-ray can assist in diagnosis process

8. Treatment
● EdURep Model
● Educate the patient about the nature of their pathology
● Unload the tissue and allow tissue healing to occur
● Reload the tissue to increase ROM and strength as
needed
● Progress treatment to mimic functional activities and meet
the demand the patient puts on the tissue in their daily
lives

9. Patient Education
● Educate the patient about how they are placing excess
stress on the involved structures
● Teach patient how to move without stressing the
sesamoids
● Re-education for squatting, standing, walking

10. Unloading Phase
● Decrease the stress on the sesamoids by dispersing
forces over the forefoot
● Use metatarsal pads or soft arch support
● Taping the 1st MTP joint into slight plantarflexion
● Lower heel height
● Avoid activities that reproduce symptoms
● No jumping
● No excessive 1st MTP dorsiflexion

11. Reloading Phase
● Once the patient is out of the inflammatory phase of
healing, progress to reloading the tissue to strengthen it
and avoid re-injury
● Exercises focusing on FHL strength
● Stretching the 1st MTP joint to improve dorsiflexion
● Improving ankle ROM

12. Progress
● Once the patient has sufficient strength and range,
progress to adding weight bearing and functional
exercises that mimic the activities the patient has to get
back to
● Squatting, jumping, running

13. References
● Anwar R., Anjum S.N., Nicholl J.E. Sesamoids of the Foot.
Current Orthopaedics. 2005. 19(1)40-48.
● Beaman D.N., Nigo L.J. Hallucal Sesamoid Injury. Operative
Techniques in Sports Medicine. 7(1)7-13.
● Image- http://sesamoiditis.net
● Image-http://www.eorthopod.com/content/sesamoid
● Image-http://www.performancefoot.com/ball-of-foot-painrelief/47-dancers-sesamoid-pad-felt-1-4inch.html
● Image- http://www.protherapysupplies.com