What's up, Doc? Sesamoiditis is common in athletes and people who walk in high heels

Q: I started to have pain in the ball of my foot after playing soccer. I thought maybe it was turf toe, but my doctor told me my tendon bone was inflamed. What is a tendon bone?

A: Most of the approximately 206 bones in the adult body connect to other bones via ligaments. However, sesamoid bones (likely what you're calling tendon bones) are more like pulleys for the tendons, in essence modifying the direction of the force the muscle applies to the bone to which is connects. They're embedded in the tendon or muscle near the surface of the joint they are affecting.

We have about 42 sesamoid bones. The one most everyone is familiar with is the kneecap (the patella), but others are in the hand, foot and wrist. Inflammation from overuse, strain, trauma and/or other injuries can affect any of our sesamoid bones, but it's most common in the two pea-shaped sesamoids by the ball of the foot (on the underside of the foot by the base of the big toe).

This condition is called sesamoiditis.

The big toe is key for us to "grip" the ground, helping us balance and change direction, and it's critical for us to walk, run, twist and jump. Sesamoiditis is more common in athletes who do a lot of running, jumping, dancing, etc., people who walk a lot in high heels and people with very high arches or with "flat feet" (where the arches on the inside of the foot flatten when pressure/weight is placed on the foot). Unsurprisingly, foot injuries are among the most common athletic injuries, accounting for over 15% of all sports-related injuries.

Turf toe is a sprain of the joint between the base of the big toe and the foot bone (metatarsal) it attaches to, and got its name from this injury becoming more common when athletes starting playing on harder/less compliant artificial turf. It's more or less a kind of sesamoiditis. It's also possible to fracture sesamoid bones; this can be an acute fracture from direct trauma or a more chronic condition from overuse (for example, from a thin crack in the bone, commonly referred to as a stress fracture).

Symptoms of sesamoiditis may include pain by the ball of the foot (especially during certain motions relying on the "pulley" action), redness, swelling and/or bruising.

The diagnosis of sesamoiditis is typically made based on the history and a physical exam, although certain imaging tests may be needed to rule out a fracture or other injury. Imaging is more commonly needed for more chronic cases, more severe symptoms or when a fracture is suspected.

Treatment of sesamoiditis includes rest, ice (to help minimize swelling and inflammation), minimizing further exacerbation of the injury, non-steroidal anti-inflammation medications and possibly physical therapy or even steroid injections. Significant fractures (for example, when parts of the bone are displaced) and more severe cases that do not respond to these less invasive measures may benefit from surgery, although this is uncommon.

If you develop sesamoiditis and/or injure the ball of your foot, you should see a health care professional to be evaluated. One key issue to discuss is when it's OK for you to return to the activity that likely caused the injury. This is because returning too soon can worsen the condition and make the overall recovery time longer, and can even lead to other injuries as you "favor" the affected foot. You can also learn about things you may be able to do to prevent re-injury; for example, modifying your athletic footwear, stretching/other exercises, etc.

Jeff Hersh, Ph.D., M.D., can be reached atDrHersh@juno.com.

This article originally appeared on MetroWest Daily News: Sesamoiditis symptoms include pain by the ball of the foot, swelling