The sesamoids are two small bones which are directly underneath and behind your great toe. They are my favorite foot bones because the name is so great! Doesn’t it sound like a snack cracker or something? How about a box of cheese flavored sesamoids—bet you can’t eat just one!

Seriously, these two bones are about the size of a lima bean in most people. Since they are on the bottom of your foot they take tremendous abuse. It is not unusual when we see x-rays of the foot to see cracked or broken sesamoids that people didn’t know they had. If you have damage to your sesamoids it can be excruciating – or not painful at all.  Sometimes it is quite painful at first but then the pain completely goes away even though the sesamoid still looks like it’s broken on the x-ray.

So what causes sesamoid pain? Usually sesamoid problems are not caused by jumping from a high distance onto a hard floor. Usually it is just standing for a really long time on hard floors or walking a long distance with worn-out shoes. I see sesamoid problems in cashiers standing behind the cash register and people working retail, teachers, nurses and anyone who’s spending a good deal of time on their feet - especially on concrete floors.

Whether there is an actual fracture or break in the sesamoid or if it is just irritated, the treatment is pretty much the same. The first and most important thing to do is to relieve the pressure on the area. A flat surgical shoe or even a surgical boot that holds the foot still but doesn’t take pressure off those small painful sesamoid bones often doesn’t help much. What does help is a thick felt pad around – but not on – the sesamoid bones. An elastic strapping of the foot also gives some immediate relief

I recently went to a professional seminar called “Sick Sesamoids.” Not only was the title a little weird but the treatment recommendations were I thought were lame. A 1/8 inch thick pad was suggested to reduce pressure on the sesamoids and if that didn’t work – then surgery to remove them. Whoa! Surgery to remove sesamoids is not only painful, it can also unbalance the joint – leading to bunions – or worse. I have only had to remove one sesamoid for trauma in over 30 years of practice, and that was a very unusual case!

So we usually need much more than 1/8 inch thick padding to let you walk comfortably. After we find out how much padding to use and where to put the padding, we can make an insert for your shoe which will do the same thing. Then you won’t have to wear pads on your foot until it heals.

The Arbor Foot Health Center has a shoe insert designed by Dr. Prant that we have created just for sesamoid problems – call us at 512-335-1800 or CONTACT US if you would like more information.