Sesamoiditis causes pain at the first metatarsophalangeal (MTP) joint from inflammation of the sesamoid bones beneath the great toe. An initial course of conservative management is the standard first step — but when pain fails to resolve within the expected timeframe, a structured next-line approach is indicated.
A first-line programme of activity modification (rest, avoidance of high-impact activities such as running, jumping, and wearing high heels), weight-bearing offloading (custom orthoses, stiffened insoles, or in-shoe soft padding), and oral NSAIDs for up to 3 weeks did not achieve resolution of sesamoid pain at the first MTP joint at rest and during weight-bearing. This non-resolution is the clinical trigger for the next treatment line.
DOI: 10.3390/medicina61071215
If symptoms persist, the judicious use of image-guided corticosteroid injections is advised.
Choi et al. included corticosteroid injections, with some patients receiving up to three ultrasound-guided injections at three-week intervals.
Physical therapy modalities (such as structured rehabilitation exercises and shockwave therapy) restore function.
Shockwave therapy uses sound waves to promote healing in the affected area, while laser therapy uses light energy to accelerate recovery and alleviate pain.
Thompson et al. documented a baseline VAS of 6, which decreased to 2 at the end of treatment and reached 0 at the one-year follow-up.
In the persistent pain group, the score remained low at 14.3 (range: 11–22), while in the pain-free group, it significantly increased to 26.6 (range: 23–32), reflecting a better functional outcome.
View source ↗