What is the sesamoid?
The sesamoid sounds strange, but there are several sesamoid bones in the body. A sesamoid is a bone embedded within a tendon or muscle. Sesamoids are usually at joints, with the kneecap being the biggest. These bones help with shock absorption and behave like pulleys for the tendons. In the foot, 2 small sesamoids exist under the big toe joint, embedded in the tendon. Constant use of the foot can cause sesamoiditis. Runners and dancers are usually prone to sesamoiditis and need immediate attention.
Removing the sesamoid bone
Most runners recover from sesamoiditis using rest, steroid injections, and medication. However, constant pain, regardless of non-surgical treatment, may need surgery. A sesamoidectomy removes one of the bones to reduce pain and inflammation. Both bones are rarely removed, as this can cause irreversible damage. Under general anesthesia, the surgeon makes a small incision at the bottom of the foot. After moving the surrounding tissue, the surgeon removes the bone and closes the incision.
The long road to recovery
After surgery, recovery starts almost immediately. The first few weeks are a delicate period, as the patient should stay off the foot as much as possible. Proper rest, wound care, and pain management becomes critical. There will be swelling and tenderness, which should improve within 12 weeks. Some physical therapy may be needed to improve the strength and range of motion. At the 6-month mark, most patients feel the full benefits of surgery.
Hitting the pavement again
After recovery, running enthusiasts will have that itch to run again. However, sesamoid bones play a crucial part in running. As the foot hits the floor, sesamoids help absorb the weight of the body. With the sesamoid removed, running places intense strain on the foot. Running can cause pain, even after surgery, so patients must allow enough time for healing. Healing and pain vary from patient to patient. However, most need up to 1 year for the foot to be fully healed. At this point, patients can gradually start running again.
Dealing with post-surgical pain
Compared to the time before surgery, runners should see a difference in pain when sedentary. However, running for an extended period will be the real test. If pain and swelling happen while running, recover with rest, ice, and medication. Make sure to wear proper footwear and avoid standing for long periods. However, if pain and swelling persist without physical activity, there could be deeper issues at play. Speak with the surgeon immediately. There could be an infection or more severe damage than first realized.
Let’s get running again
These 2 small bones can cause runners severe and chronic pain. In some cases, the only way to recover is through surgery. The sesamoid removal will limit runners, especially in the first year after surgery. Proper pain management and observation after recovery helps tremendously. Speak with the surgeon about future desires to run again to form the right treatment plan.