Dancer's FootSesamoid bones are one of nature’s most amazing anatomical creations. Sesamoid bones are unique in that they are “floaters” - not connected to another bone - and they are embedded in a tendon or muscle. They provide a smooth surface over which tendons can slide to increase mechanical (muscle) power. The leverage advantage produced by the exact location of this bone gives us leg power (patella bone) as well as foot movement. The sesamoids in the forefoot (directly under the first toe joint) assist with weight bearing and help elevate the bones of the great toe.
Like other bones, sesamoids can break and tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis. When the patella is dislocated or the Q angle (angle between thigh bone and larger shin bone) is excessive, the patella may not glide smoothly each time the leg is flexed or extended. If the underside of the patella loses its smoothness a condition called chondromalacia may develop.
On the underside of great toe there are two sesamoid bones. The great (big) toe is critical to walking, dancing and running. These two sesamoid bones improve the angle and effectiveness of the toe-off portion of the gait cycle. When injured there may be no swelling and bruising with pain localized directly under the joint of the big toe. If this pain appears quickly you should seek physician care for an x-ray. If you experience pain bending/straightening the big toe even when non-weight bearing, suspect sesamoiditis.
The American Academy of Orthpaedic Surgeons offers the following guidance for sesamoiditis:
- Stop the activity causing the pain.
- Take aspirin or ibuprofen to relieve the pain.
- Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
- Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
- Use a felt cushioning pad 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.
- Tape the great toe so that it remains bent slightly downward (plantar flexion).
- Your doctor may recommend an injection of a steroid medication to reduce swelling.
- If symptoms persist, you may need to wear a removable short leg fracture brace for 4 to 6 weeks.
There are specific pads for sesamoiditis in the foot that are intended to re-distribute body weight off of the bones upon weight bearing. Find these pads on the Sports Health’s web site >>