The aching sesamoid of the great toe

Medically Reviewed By : Dr K. Hari Chandana

MBBS, MS ORTHOPAEDICS
( Fellowship in Trauma, Fellowship in Pain Management )

Introduction

Pain in the big toe can be an uncomfortable and constricting problem that many people experience. This discomfort could be brought on by a number of different situations, from small accidents to more serious illnesses. The great toe is an essential component of our mobility because it balances us while we walk and supports our body weight. Its anguish can have a big impact on how we go about our daily lives. For an accurate diagnosis and efficient care, it is crucial to comprehend the underlying causes. Trauma, such as stabbing or hurting the toe, overuse, wearing improper footwear, gout, arthritis, ingrown toenails, and nerve compression are common causes of great toe discomfort. Finding the underlying issue is the first step in reducing discomfort and enhancing general foot health.

Causes

Pain in the big toe, often referred to as big toe joint pain, has a variety of causes and is associated with a number of diseases. Possible reasons include:

Arthritis: Pain and inflammation may result from osteoarthritis of rheumatoid arthritis in the big toe joint.
Gout: Gouty arthritis can develop when uric acid crystals accumulate in the joint and cause sudden, severe pain.
Bunions: The big toe's base growing bone might result in pain and a misaligned joint.
Injury or Trauma: Pain can result from big toe fractures, sprains, or strains.
Turf Toe: Sportspeople who play on artificial turf are more likely to hyperextend (beyond its normal limit) their big toe joints, which can lead to this condition.
Ingrown Toenails: On the side of the big toe, ingrown toenails can cause pain and irritation.
Nerve Entrapment: Pain and tingling in the big toe joint might result from the compression of adjacent nerves.

Symptoms:

Pain in the big toe signs and symptoms include:

Diagnosis

In order to identify the cause of Pain in the big toe, a healthcare professional, frequently a podiatrist or orthopedic doctor, will conduct a physical examination, inquire about the patient’s medical history, and inquire about any recent injuries. To evaluate the state of the joint and rule out fractures or other structural problems, imaging procedures like X-rays or MRI scans may also be prescribed.

Radiographs: The tibial injury may be seen more clearly with a lateral inclined view than the fibular injury, which can be seen more clearly with a medial inclined view.
Radioactive bone scan: Radioactive bone scanning can identify an altered uptake before radiographs reveal changes. It displays higher uptake prior to the emergence of radiological abnormalities including lesions and fracture. Bone scanning can be used to tell the fractured sesamoid apart from the naturally split sesamoid.
MRI: MRI imaging is a valuable technique for determining the pain in the big toe and source of injury discomfort in situations where a diagnosis would often be difficult to figure out.
Regularly stretch your feet and toes to increase your flexibility and strength.

Differential diagnosis:-

A persistent ankle keratosis: Below the pointed ends of the metatarsals, a persistent ankle keratosis can develop. Repeated abrasion or increased exercise are frequently the causes of this. To find the underlying abnormalities, radiographs may be useful. A cut or operation may be necessary in cases of chronic symptoms.
Bursitis:- Finding the damaged bursa's location may be assisted by magnetic resonance imaging. Bursectomy, either by itself or in conjunction with sesamoidectomy or metatarsal osteotomy, may be used as a last resort if conservative methods fail.
Nerve compression: Plantar medial as well as plantar lateral digital nerves are located close to one another and could be painfully compressed. These locations may experience discomfort and altered sensation. Surgical decompression may be necessary.
Osteoarthritis: Trauma and sesamoiditis (inflammation of great toe) can contribute to the development of this. Resection (cut) of the affected sesamoid may be helpful if the illness is contained to one sesamoid and conservative therapy is unsuccessful.
Infection: Sesamoid infection is not widespread. In those with peripheral neuropathy, direct trauma with a puncture wound or skin disintegration are the typical mechanisms.
- Sesamoid excision may be an option if antibiotic treatment is unsuccessful.
- When removing the sesamoids, caution should be used to protect the nearby structures in order to prevent the emergence of an inherent minus deformity.
Fracture of the sesamoid: Using a bone scan or MRI, it is possible to distinguish between a congenital bipartite sesamoid and an acute fracture of the uni partite sesamoid.
- Bipartite sesamoids can also fracture as a result of trauma when the synchondrosis between the two sesamoid parts prevents the joint from mending.
- The first course of therapy is to rest in a non-weight-bearing cast for 6 to 8 weeks.
- Treatment options for symptomatic nonunion include open fixation, open bone grafting, and percutaneous screw fixation.
- Excision surgery could be saved for revision surgery.

If you are experiencing any of these symptoms, it is important to seek a doctor’s advice for an accurate diagnosis and appropriate treatment.

Treatment

The following alternatives for treatment may be taken into consideration depending on the underlying cause of the discomfort:

Resting the foot and staying away from things that make the discomfort worse
Resting the foot and staying away from things that make the discomfort worse
Managing pain and swelling using over-the-counter painkillers such as paracetamol or nonsteroidal anti-inflammatory medications (NSAIDs).
Donning comfortable, supportive shoes with strong arch support
Adding extra joint support and alignment by using orthotics or personalized shoe inserts
Attending physical therapy sessions to bolster and enhance joint flexibility.
Injecting corticosteroids to decrease inflammation in specific circumstances
If conservative therapy is unsuccessful, think about surgery for severe bunions or prolonged joint problems.

Surgery:

The treatment of heel pain depends on the underlying cause of the pain. Here are some of the most common treatments for heel pain:

Sesamoid shaving: Shaving the plantar half of the sesamoid may give relief in cases of a persistent ankle keratosis brought on by the prominence of a tibial sesamoid without removing the entire sesamoid. Only when the first metatarsal is mobile normally should this be tried.
Sesamoidectomy: Only after alternative treatment options have failed can surgical removal of a sesamoid be attempted. A cock-up deformity or claw toe deformity is probable if both sesamoid bones are removed; only one sesamoid may be removed.
The type of sesamoid that needs to be removed will determine the surgical approach. To prevent damage to the plantar medial nerves, a medial approach is suggested for tibial sesamoidectomy.
Percutaneous screw fixation: Percutaneous fixation of the sesamoid may alleviate symptoms in situations of sesamoid fractures that don't respond to conservative treatment.
At three months following surgery, all nine patients in one trial who were treated in this manner saw a considerable reduction in pain.

Prevention

People can adhere to the following guidelines to prevent Pain in the big toe:

Use sensible footwear that fits well and offers sufficient support.
Avoid certain activities that put too much stress on the big toe joint.
In order to relieve pressure on your joints, maintain a healthy weight.
Regularly stretch your feet and toes to increase your flexibility and strength.

It’s essential to see a medical expert for a precise diagnosis and a treatment plan that is unique to the patient’s situation.

Conclusion

Pain in the big toe can have a variety of causes, and it can have a minimally irritating to significantly impairing effect on everyday activities. For effective treatment and prevention, it is essential to identify the origins of this pain. Getting medical help as soon as possible is crucial, whether it’s for a straightforward instance of overuse or a more complicated problem like gout or arthritis. In many cases, alleviation can be found with rest, the right footwear, and home care, but severe or persistent pain needs medical attention. People can restore their mobility and experience a pain-free great toe with the appropriate diagnosis and treatment strategy, allowing them to continue to walk confidently through life.