Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion Criteria
- Population/patients: Individuals diagnosed with sesamoiditis (based on clinical and imaging findings), including athletes (amateur, semi-professional, professional, and elite) and non-athletes, of either sex/gender, aged 16 years or older.
- Intervention: Implementation of conservative treatments for sesamoiditis, including physiotherapy, physical therapies (such as shockwave or laser therapy), corticosteroid injections, and/or orthotics.
- Comparator: Studies were selected if they included pre- and post-intervention measurements.
- Outcome: Studies reporting outcomes such as pain reduction at rest or during activity, improvement in quality of life, and return to activity or sport were included. Studies using the following validated scales or questionnaires were deemed eligible: the Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS) for pain-related outcomes; the Foot and Ankle Ability Measure (FAAM) divided into two subscales, i.e., FAAM-Sport and FAAM-ADL, for function-related outcomes and to evaluate functional capacity in sports and activities of daily living (ADL) for individuals with foot or ankle problems; and the Foot and Ankle Outcome Score (FAOS), used to assess clinical outcomes (symptoms, pain, ADL, sports and leisure activities, and quality of life) related to foot and ankle disorders.
2.3. Exclusion Criteria
2.4. Study Selection
2.5. Data Extraction
2.6. Quality Assessment
2.7. Statistical Analysis and Individual-Level Data Pooled Analysis
3. Results
3.1. Literature Search
3.2. Demographics of the Studies Included
3.3. Conditions
3.4. Treatment Protocols
3.5. Outcomes
3.5.1. Pain-Related Outcomes
VAS
NRS
3.5.2. Function-Related Outcomes
FAAM
FAOS
3.5.3. Return to Activity
3.6. Quality Assessment
4. Discussion
4.1. Strengths and Limitations
4.2. Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BMI | Body Mass Index |
CBMA | Concentrated Bone Marrow Aspirate |
FAAM | Foot And Ankle Ability Measure |
FAOS | Foot And Ankle Outcome Score |
JBI | Joanna Briggs Institute |
MTP | Metatarsophalangeal |
NSAIDs | Nonsteroidal Anti-Inflammatory Drugs |
NRS | Numeric Rating Scale |
NWB | Non-Weight-Bearing |
PAC | Passive Axial Compression |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
PRP | Platelet-Rich Plasma |
RCT | Randomised Controlled Studies |
VAS | Visual Analogue Scale |
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Database | Search Strategy |
---|---|
Scopus | TITLE-ABS-KEY (sesamoid*) AND TITLE-ABS-KEY (human) AND TITLE-ABS-KEY (conservative OR therapy OR rehabilitation OR treatment OR exercise) |
PubMed/MEDLINE | (sesamoid*) AND (conservative OR therapy OR rehabilitation OR treatment OR exercise) AND human |
ISI/Web of Science (WoS) | sesamoid* (Topic) AND (conservative OR therapy OR rehabilitation OR treatment OR exercise) (Topic) |
PEDro | Abstract and Title: sesamoid* |
Study | Study Design | Sample Size (Female/Male) | Age | Athletic Subjects | Follow-Up | Patients Excluded/Lost to Follow-Up |
---|---|---|---|---|---|---|
Axe and Ray, 1988 [28] | Retrospective case series | 10 (6/4) | 22.7 ± 4 (median 21.5 [17–30]) | 10 (college-level football player, n = 4; college-level shot putter, n = 1; professional dancer, n = 1; recreational athletics, n = 2; scholastic marching band member, n = 1; distance jogger, n = 1) | 19.7 months [9–24] | 0 |
Frey & Koehle, 2013 [26] | Case report | 1 (1/0) | 63 | 1 (recreational runner) | 4 months | 0 |
Shin et al., 2013 [24] | Case report | 1 (1/0) | 29 | 0 | 1 day | 0 |
Kumar et al., 2015 [22] | Case report | 1 (0/1) | 49 | 0 (bus driver) | Lost to follow-up | Lost to follow-up |
Aşkın et al., 2017 [27] | Retrospective case series | 2 (2/0) | 31 ± 1.4 [30–32] | 0 | 1.5 ± 0.7 months [1,2] | 0 |
Thompson et al., 2017 [25] | Case report | 1 (0/1) | 52 | 1 (recreational club tennis player) | 1 year | 0 |
Shimozono et al., 2022 [30] | Retrospective case series | 13 (10/3) out of 15 consecutive patients initially included | 26.9 [16–39] | 11/13 (professional level, n = 4; college level, n = 3; recreational level, n = 4) | 20.1 months [12–34] | 0 |
Benslima et al., 2023 [21] | Case report | 1 (1/0) | 30 | 1 (recreational runner) | 1 month | 0 |
Callahan et al., 2024 [20] | Case report | 1 (1/0) | 28 | 1 (professional musical theatre performer, dancing ballet and hip hop) | 2 years | 0 |
Choi et al., 2024 [29] | Prospective case series | 27 (6/21) | 40 ± 11.5 [24–67] | 27 (running, n = 8; golf, n = 5, weightlifting with squatting, n = 5; sports dancing, n = 5; futsal, n = 4) | 6 months | 9 (4 lost after initial treatment, 2 after injection, 3 after brace application with crutches) |
Maganinho et al., 2024 [23] | Case report | 1 (1/0) | 22 | 1 (professional dancer or “ballerina”) | 3 months | 0 |
Study | Number of Feet Treated (Right/Left) | Total Sesamoids (Medial/Lateral) | Condition | Duration of Symptoms | Treatment | Duration of Treatment | Time Between Diagnosis and Start of Treatment |
---|---|---|---|---|---|---|---|
Axe and Ray, 1988 [28] | 10 (6/4) | 10 (6/4) | Sesamoid pain (“a sharp pain beneath the first metatarsal head upon weightbearing”) | From 1 week to >2 years | Custom-fitted orthoses | From 2 to 21 months (full-time); from 4 to 22 months (part-time) | 10 days |
Frey & Koehle, 2013 [26] | 1 (1/0) | 1 (1/0) | Sesamoiditis (“pain … notably worse with weight bearing and aggravated by certain types of footwear”) | 7 months | Two local corticosteroid injections (5 mg dexamethasone and 0.75 cc 1% lidocaine during the first injection and 6mg of dexamethasone in 1 cc 1% lidocaine during the second injection) | Two injections interspersed by 1 month | 10 months |
Shin et al., 2013 [24] | 2 (1/1) | 4 (2/2) | Symptomatic hallucal interphalangeal sesamoid bones (“lower-extremity pain …, which was in the toes, … described as continuous, throbbing, crushing, and burning” and walking difficulties) | 9 months (3 months postpartum) | One ultrasound-guided injection of 0.125% levobupivacaine mixed with 10 mg of triamcinolone acetonide. | 1 day | 0 days |
Kumar et al., 2015 [22] | 1 (1/0) | 2 (1/1) | Subhallucal interphalangeal sesamoiditis (pain “aggravated during application of brakes while driving”) | 5 years | One ultrasound-guided local injection of 1 mL of 0.125% levo-bupivacaine mixed with 10 mg of triamcinolone acetonide + the patient was advised to use a soft pad within the shoe underneath the symptomatic area, along with oral analgesic for 2 months | 2 months (but patient lost to follow-up) | 0 days |
Aşkın et al., 2017 [27] | 2 (2/0) | 2 (2/0) | Sesamoid osteonecrosis | From 10 days to 1 month | (1) Short leg cast for 20 days + contrast bath therapy + TENS 20 min/day + exercise (ROM, progressive resistance, and balance/coordination exercise) (2) Rest + orthopaedic insole + contrast bath therapy | 1–2 months | 0 days |
Thompson et al., 2017 [25] | 1 (0/1) | 1 (0/1) | Sesamoiditis and sesamoid osteonecrosis (pain “aggravated by walking and playing recreational tennis”) | 1 year | Eight sessions of radial extracorporeal shock wave therapy | NA | 6 weeks |
Shimozono et al., 2022 [30] | 13 (5/8) | 13 (10/3) | Sesamoid hallux disorders (including sesamoiditis, symptomatic bipartite sesamoids, and avascular necrosis) | 11.8 months (from 3 months to 3 years) | One concentrated bone marrow aspirate (CMBA) injection, then 2 weeks of non-weight-bearing postinjection, then full weightbearing was permitted as tolerated with customised orthotics for 3 months; return to play granted 3 months post injection | 3 months and 2 weeks | ≥3 months of failed previous conservative management (restriction of activities, custom orthotics, nonsteroidal anti-inflammatory drugs, physiotherapy, extracorporeal shockwave therapy, and platelet-rich plasma injection) |
Benslima et al., 2023 [21] | 1 (1/0) | 1 (1/0) | Hallucal sesamoiditis (“chronic great toe pain that had been evolving for several years”) | 3 weeks | Non-steroidal-anti-inflammatory-drugs for 5 days + 3 months rest period Only low-impact activities (es. swimming) were recommended | 1 month | 0 days |
Callahan et al., 2024 [20] | 1(0/1) | 1 (0/1) | Sesamoid osteonecrosis (worsening, aching, and stabbing pain) | 6 weeks | One Leukocyte-Rich Platelet-Rich Plasma injection under ultrasound guidance + use of axillary crutches and no weight bearing for the next week + physical therapy for the next 2 weeks post-injection | 1 month | 15 weeks after failure of conservative therapy (12 weeks of physical therapy, oral nonsteroidal anti-inflammatory drugs, and sesamoid offloading with padding + 3 weeks of use of a CAM boot) |
Choi et al., 2024 [29] | 27 (12/15) | 27 (27/0) | Atraumatic medial sesamoid pain | NA | Stepwise conservative treatment: (a) 3 weeks of oral analgesics, activity restriction and wearing stiffened offloading insoles; (b) and (a) ultrasound-guided local corticosteroid injection of triamcinolone (40 mg) mixed with 1% lidocaine (1 mL); (c) ultrasound-guided local corticosteroid injections attempted at 3-week intervals (maximally 3 times); (d) boot walker application with crutches for 3 weeks | 3–4.5 months [12–18 weeks] | 0 d |
Maganinho et al., 2024 [23] | 1 (1/0) | 1(1/0) | Osteonecrosis of subhallucal sesamoid bone (“mechanical right forefoot pain …, mostly at the tiptoe dancing movements … and, after a few months … present even when walking”) | 1 year | One ultrasound-guided injection of 1 mL of 1% lidocaine mixed with 10 mg of triamcinolone acetonide between the sesamoid bone and the flexor hallux longus tendon | 1 day | 0 days |
Study | Scale | Pain Before Treatment | Pain After Treatment |
---|---|---|---|
Shin et al. (2013) [24] | NRS | 8 of 10 | 0 of 10 |
Thompson et al. (2017) [25] | VAS | 6 of 10 | 2 of 10 after finishing the treatment 0 of 10 after 1 year |
Shimozono et al. (2022) [30] | VAS | 5.8 (range 4–8) | 1.5 (range 0–4) |
Callahan et al. (2024) [20] | NRS | 4 of 10 | 0 of 10 after 2 months 4 of 10 after 2 years |
Choi et al. (2024) [29] | VAS | 8.3 (range 6 to 10) | Group 1: persistent pain after 3 months conservative treatment (n = 14) 6.7 (range 5 to 9) Group 2: relieved pain after 3 months conservative treatment (n = 13) 2.3 (range 1 to 5) |
Study | Scale | Functionality Before Treatment | Functionality After Treatment |
---|---|---|---|
Shimozono et al. (2022) [30] | FAOS | Symptoms 64 (7.4) Pain 56.1 (11.4) Daily activities 68.9 (8.6) Sports activities 36.8 (9.4) Quality of life 30.5 (8.2) Overall 51.3 (5.6) | Symptoms 90.8 (7.5) Pain 83.8 (17.4) Daily activities 92.8 (7.3) Sport activities 72.5 (20.1) Quality of life 64.6 (22.7) Overall 81.4 (13.4) |
Choi et al. (2024) [29] | FAAM-ADL | 14.7 (12 to 21) | Group 1: 14.3 (11 to 22) Group 2: 26.6 (23 to 32) |
FAAM-Sports | 51.9 (42 to 63) | Group 1: 52.1 (42 to 64) Group 2: 73.4 (68 to 79) |
Study | Return to Activity |
---|---|
Axe and Ray (1988) [28] | Five varsity athletes: three patients had immediate and almost complete relief of symptoms with orthoses, one patient had a gradual resolution of symptoms over 4 weeks, one required 6 weeks for pain resolution. Without orthoses, three had persistent symptoms during basketball and one during activities of daily living. They refused surgery. Two recreational runners remained symptomatic without the orthoses and used them prophylactically. Without orthoses one patient had persistent symptoms during aerobics and the other while wearing heels. They refused surgery. One musician became immediately asymptomatic with the orthoses and then without orthoses. The remaining two patients underwent the surgical excision of a sesamoid. In particular, the professional dancer returned to ballet after 3 months and the jogger to extended distances after 3 months (post surgery). |
Frey and Koehle (2013) [26] | After 3 months, the patient was able to return to running, and 4 months later she completed a 10 km race in 75 min with minimal ongoing discomfort. |
Shin et al. (2013) [24] | The following day the patient reported no pain and went shopping. |
Thompson et al. (2017) [25] | The patient returned to playing tennis 6 weeks after completing the treatment and undergoing a 12-week sport-specific rehabilitation programme. |
Shimozono et al. (2022) [30] | Eight of eleven (73%) patients that were involved in sports prior to the CBMA injection returned to play, with seven successfully returning to preinjury level status (three professional, one college, and three recreational levels). |
Callahan et al. (2024) [20] | After 3 months, the patient returned to regular ballet auditions. |
Choi et al. (2024) [29] | Group 1 after 6 months (n = 12): Able to reach prior level of sports activity without pain: 0 (0%); Able to participate in sports, but experiencing mild post-sports MSP: 3 (25%); Able to perform activities of daily living, but experiencing MSP during sports activities and unable to engage in sports: 5 (41.7%); Experiencing residual MSP during activities of daily living: 4 (33.3%). Group 2 after 6 months (n = 11): Able to reach prior level of sports activity without pain: 5 (45.4%); Able to participate in sports, but experiencing mild post-sports MSP: 4 (36.4%); Able to perform activities of daily living, but experiencing MSP during sports activities and unable to engage in sports: 2 (18.2%); Experiencing residual MSP during activities of daily living: 0 (0%). |
Study | Quality Items | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | |
Case Series Studies | ||||||||||
Axe and Ray (1988) [28] | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | N/A |
Aşkın et al. (2017) [27] | N/A | Yes | Yes | No | Yes | Yes | Yes | Yes | N/A | N/A |
Shimozono et al. (2022) [30] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | N/A |
Choi et al. (2024) [29] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | N/A |
Case Reports | ||||||||||
Frey and Koehle (2013) [26] | Yes | Yes | Yes | Yes | Yes | Yes | N/A | Yes | – | – |
Shin et al. (2013) [24] | Yes | Yes | es | Yes | Yes | Yes | N/A | Yes | – | – |
Kumar et al. (2015) [22] | Yes | Yes | Yes | Yes | Yes | N/A | N/A | Yes | – | – |
Thompson et al. (2017) [25] | Yes | Yes | Yes | Yes | Yes | Yes | N/A | Yes | – | – |
Benslima et al. (2023) [21] | Yes | Yes | Yes | Yes | Yes | Yes | N/A | Yes | – | – |
Callahan et al. (2024) [20] | Yes | Yes | Yes | Yes | Yes | Yes | N/A | Yes | – | – |
Maganinho et al. (2024) [23] | Yes | Yes | Yes | Yes | Yes | Yes | N/A | Yes | – | – |
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© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Biz, C.; Maccarone, M.C.; Bonso, V.; Belluzzi, E.; Masiero, S.; Bragazzi, N.L.; Ruggieri, P. Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis. Medicina 2025, 61, 1215. https://doi.org/10.3390/medicina61071215
Biz C, Maccarone MC, Bonso V, Belluzzi E, Masiero S, Bragazzi NL, Ruggieri P. Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis. Medicina. 2025; 61(7):1215. https://doi.org/10.3390/medicina61071215
Chicago/Turabian StyleBiz, Carlo, Maria Chiara Maccarone, Valentina Bonso, Elisa Belluzzi, Stefano Masiero, Nicola Luigi Bragazzi, and Pietro Ruggieri. 2025. "Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis" Medicina 61, no. 7: 1215. https://doi.org/10.3390/medicina61071215
APA StyleBiz, C., Maccarone, M. C., Bonso, V., Belluzzi, E., Masiero, S., Bragazzi, N. L., & Ruggieri, P. (2025). Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis. Medicina, 61(7), 1215. https://doi.org/10.3390/medicina61071215