Feet > Sesamoid Disorders > Treatments

   Non-Operative Treatments

Treatment Introduction

Sesamoid disorders, including inflammation, sesamoiditis, or fractures, may be treated symptomatically. This means your physician prescribes enough support and rest so that you can walk around without feeling pain. Everyone’s specific treatment is slightly different, based on your pain tolerance and your body’s natural ability to heal. In general, a sesamoid disorder heals over the course of about six weeks. A combination of the following non-surgical treatments may be used to treat your sesamoid disorder:

   Relative rest – Decreasing the intensity and duration of your activities can help decrease your pain. You may need to stop running and switch to other aerobic activities that are easier on your feet, such as swimming.

   Decreased heel height – Wearing shoes with lower heels than you were wearing when the injury occurred can lessen the strain on the ball of your foot.

   Taping – To decrease bending in your big toe, the simplest taping method involves putting the middle of a strip of athletic tape over the top of your big toe, just below the toenail. The tape is wrapped around your toe, crossing underneath the ball of your foot, with the ends taped to the bottom of your midfoot. Physicians generally recommend you visit a qualified athletic trainer to have your toe taped.

   Orthotic shoe insert – A molded orthotic insert that adds height to the outside of your foot can transfer some of your body weight to the outside of your foot and relieve stress under your big toe.

   Cast shoe – These open-toe sandals made of wooden or hard plastic bottoms are designed so that your toes do not bend when you walk.

   Medication – Anti-inflammatory medication can help ease the pain.

   Steroid injection – Used sparingly, a steroid injection can help ease pain and decrease swelling. Steroids are not used when your sesamoid is fractured or cartilage is damaged.

If your sesamoid has been fractured or if other conservative treatments do not ease your pain, your foot may be immobilized in a cast or brace.

A short leg walking cast wraps around your foot, ankle, and lower leg. It starts below your knee and is open around your toes to allow toe movement. Short leg casts are made of layers of fiberglass. Your physician usually rolls a thin, elastic stocking, called a stockinette, over your skin. A dry layer of fiberglass is wrapped around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer.

Many patients receive pain relief by wearing a brace called a cam walker. A cam walker is a removable boot, made of nylon straps that fasten around your calf and foot. Most cam walkers have an adjustable hinge at the ankle that can be set to allow the range of motion your physician prescribes. The sturdy bottom of the cam walker is rocker shaped, which enables you to walk without bending your toes. You typically can walk around pain-free in a cam walker, but you should avoid any strenuous activities or long duration walks. You typically will wear the cast or cam walker for about six weeks until you can return to normal shoe wear without pain. If pain persists, the cam walker may need to be worn for an extended period of time.

Take it easy on your foot until you can walk in normal shoes without pain. This may take about six weeks, depending on how fast your body heals and how much damage was done to your sesamoid. Continue wearing your cast shoe, cam walker, or short leg cast as prescribed. Most patients return to their physician’s office a few weeks after treatment begins for a check-up and X-rays. Your cast may be removed after two weeks and you may be put into a removable cam walker if you need continued support as you begin walking. If the pain goes away and your physician sees signs of healing after six weeks, you typically can return to normal shoe wear. When you can tolerate the pain, a period of relative rest begins, which lasts until your foot can withstand the stress of the activity that caused the sesamoid disorder. Relative rest means that you need to keep your activity level below your level prior to injury. Though the pain has gone away from your foot, you are still at risk for reinjury if you return to the same activity that led to overuse and caused the injury. In some cases, your pain may continue for a prolonged period of time. After four to six months of conservative treatment without results, you may become a candidate for surgery to remove the injured sesamoid.

Formal physical therapy may not be necessary after a sesamoid disorder. Many patients can adequately restore motion and strength in their big toe with a regular cardiovascular exercise program. Most patients can return to sports and activities within two or three months after the injury. Begin exercising with short walks and increase the duration and intensity as pain allows. You may be able to use stationary cycles or swim without causing much pain in your foot about two weeks after the injury, except when you are wearing a cast. When your pain is gone, start with low impact exercises. Progress to light jogging before sprinting, jumping, and cutting. More vigorous running and exercise typically can begin within eight weeks after treatment begins. Gradually return to activities with pain as your guide. Understand that your level of activity prior to the injury was somewhere above your foot’s threshold to withstand the forces and stress of that activity. Increase your workouts slowly, and if pain returns, decrease the intensity and duration of your walks, runs, or other physical activities.

The best way to prevent reinjury in your sesamoid is to be sure that your big toe is flexible and strong before you begin repetitive running, jumping, and cutting motions. The risk of reinjuring your sesamoid is small if it heals properly. Returning to activities before your pain has gone away and increasing your activity level too quickly may cause pain and symptoms to flare up again. Proper footwear, designed for your particular sport or activity, can help protect your foot against abnormal strain in your big toe joint. Avoid wearing old, worn-out shoes when you are running or participating in activities that pound your feet. In general, shoes with higher heels put more strain on the ball of your foot and should be avoided. Depending on the shape of your foot, you may benefit from orthotic devices molded to decrease the strain that passes through the ball of your foot when you walk or run. Your physician typically has these molded for you if necessary.