Caring Medical - Where the world comes for ProlotherapySesamoiditis treatments with Prolotherapy

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, PA-C

In this article, we will discuss the problems and treatment of big toe pain centered on a diagnosis of sesamoiditis.

If you have questions about Sesamoiditis treatments with Prolotherapy, get help from our Caring Medical staff

The sesamoid bones of the foot are tiny bones. They are among the very few bones that are not attached to other bones. It is important to know this because the sesamoid bones then act in a unique way in their function to help transmit muscle force in the foot. As they are only attached to the tendon of the flexor hallucis longus muscle, the sesamoids can then act independently like a fulcrum in a pulley, distributing weight and the force that is required to move that weight. Like the fulcrum the tiny sesamoid bones can properly distribute force and weight far in excess of its own size.

So you have a tendon, with force and weight on both sides, balanced by the sesamoids. When that balance is disrupted by injury or overuse, the tendon becomes irritated and inflamed and a diagnosis, mostly affecting runners and dancers  of sesamoiditis is made.  Standard treatment for sesamoiditis include rest, ice and special shoe pads. Unresolved sesamoiditis pain involves removing the sesamoid bones.

Doctors at the Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland have published their findings on various stress fractures that affect athletes. In discussing sesamoiditis, the Scottish researchers found:

  • Sesamoiditis is commonly seen in sports which involve repeated, forced dorsiflexion (backward bending) of the great toe. These sports include dancing, gymnastics and sprinting. The medial (tibial) sesamoid is most frequently injured due to its positioning directly beneath the head of the first metatarsal.
  • Current management protocols advocate conservative management as the first line treatment for all such injuries.
    • This comprises rest/immobilization, with a period of 4 to 8 weeks limited-weightbearing in below knee cast, or moonboot.
    • Following this, weight bearing should be progressed, using a forefoot offloading shoe or modified orthotic.
    • Return rates to sport following successful conservative management include 100%, with return times ranging 3 weeks to 1 year.
    • There is however a high rate of delayed union, nonunion, and recurrence with this treatment, so if the patient remains symptomatic after 3 to 6 months of conservative treatment, surgical intervention should be considered.
    • Conversion from conservative management to surgical management ranges from 33% to 100% in the published studies.
    • Reported return rates following surgery range from 90% to 100% with return times ranging 2.5 to 6 months.1

These researchers have found, what others have, a lot of contradictory studies. One report says 100% of athletes can return to their sport with conservative care, while another says 100% of those in conservative care eventually move onto surgical intervention. Clearly there can only be 100% of anything and these numbers offer contradiction.

In research from the Department of Sports Medicine, Palo Alto Medical Foundation doctors suggest:

  • Sesamoidectomy of the first metatarsophalangeal joint in athletically active patients may be indicated in cases of chronic sesamoiditis that do not respond to nonsurgical care or if there is symptomatic displaced fractures or nonunion.
    • Painful scar (neuroma-like symptoms), hallux deviation (bunion), and delayed return to activity are all potential complications. These need to be considered especially when performing surgery in the athletically active individual.2

Sesamoiditis Pain Treatment

Doctors writing in the Bone and Joint Journal suggest that patients with hallux valgus may require different approaches and that a variety of surgical options are offered because one is best suited for each specific type of hallux valgus.3 However, even choosing the correct treatment for each specific condition can leave the patient with ongoing problems.4

Rest and ice are two treatments that can actually inhibit healing. What’s needed in this type of pain is regeneration of weakened structures. Rest and ice both inhibit blood flow, eliminating any chance of the body’s immune system repairing the weakened area. A better option is Prolotherapy, an injection technique that induces inflammation, ushering in healing factors to strengthen the weakened area


If you have questions about Sesamoiditis treatments with Prolotherapy, get help from our Caring Medical staff

1 Robertson GA, Wood AM. Lower limb stress fractures in sport: Optimising their management and outcome. World J Orthop. 2017 Mar 18;8(3):242-255. [Pubmed]

Saxena A, Krisdakumtorn T. Return to activity after sesamoidectomy in athletically active individuals. Foot Ankle Int. 2003 May;24(5):415-9. [Pubmed]

3 Robinson AH, Limbers J: Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br 2005, 87(8): 1038 – 1045. [Citation]

4. Hauser RA, Feister WA, Dextrose Prolotherapy with Human Growth Hormone to Treat Chronic First Metatarsophalangeal Joint Pain. The Foot and Ankle Online Journal 5 (9): 1 [Citation]


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