Sesamoid Injuries in the Foot
![Sesamoid]()
What is a
Sesamoid?
A sesamoid
is a bone embedded in a tendon. Sesamoids are found in several joints in the
body. In the normal foot, the sesamoids are two pea-shaped bones located in the
ball of the foot, beneath the big toe joint.
Acting as a pulley for tendons, the sesamoids help the big
toe move normally and provide leverage when the big toe “pushes off” during
walking and running. The sesamoids also serve as a weight-bearing surface for
the first metatarsal bone (the long bone connected to the big toe), absorbing
the weight placed on the ball of the foot when walking, running, and jumping.
Sesamoid injuries can involve the bones, tendons, and/or
surrounding tissue in the joint. They are often associated with activities
requiring increased pressure on the ball of the foot, such as running,
basketball, football, golf, tennis, and ballet. In addition, people with high
arches are at risk for developing sesamoid problems. Frequent wearing of
high-heeled shoes can also be a contributing factor.
Types of
Sesamoid Injuries in the Foot
There are three types of sesamoid injuries in the foot:
- Turf
toe. This is an injury of the soft tissue surrounding the big toe
joint. It usually occurs when the big toe joint is extended beyond its
normal range. Turf toe causes immediate, sharp pain and swelling. It
usually affects the entire big toe joint and limits the motion of the toe.
Turf toe may result in an injury to the soft tissue attached to the
sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the
moment of injury.
- Fracture.
A fracture (break) in a sesamoid bone can be either acute or chronic.
- An acute fracture
is caused by trauma – a direct blow or impact to the bone. An acute
sesamoid fracture produces immediate pain and swelling at the site of the
break, but usually does not affect the entire big toe joint.
- A chronic fracture
is a stress fracture (a hairline break usually caused by repetitive
stress or overuse). A chronic sesamoid fracture produces longstanding
pain in the ball of the foot beneath the big toe joint. The pain, which
tends to come and go, generally is aggravated with activity and relieved
with rest.
- Sesamoiditis.
This is an overuse injury involving chronic inflammation of the sesamoid
bones and the tendons involved with those bones. Sesamoiditis is caused by
increased pressure to the sesamoids. Often, sesamoiditis is associated
with a dull, longstanding pain beneath the big toe joint. The pain comes
and goes, usually occurring with certain shoes or certain activities.
Diagnosis
In diagnosing a sesamoid injury, the foot and ankle surgeon will examine
the foot, focusing on the big toe joint. The surgeon will press on the big toe,
move it up and down, and may assess the patient’s walking and evaluate the wear
pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced
imaging studies may be ordered.
Non-Surgical
Treatment
Non-surgical treatment for sesamoid injuries of the foot may include one or
more of the following options, depending on the type of injury and degree of
severity:
- Padding,
strapping, or taping. A pad may be placed in the shoe to cushion
the inflamed sesamoid area, or the toe may be taped or strapped to relieve
that area of tension.
- Immobilization.
The foot may be placed in a cast or removable walking cast. Crutches may
be used to prevent placing weight on the foot.
- Oral
medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such
as ibuprofen, are often helpful in reducing the pain and inflammation.
- Physical
therapy. The rehabilitation period following immobilization
sometimes includes physical therapy, such as exercises (range-of-motion,
strengthening, and conditioning) and ultrasound therapy.
- Steroid
injections. In some cases, cortisone is injected in the joint to
reduce pain and inflammation.
- Orthotic
devices. Custom orthotic devices that fit into the shoe may be
prescribed for long-term treatment of sesamoiditis to balance the pressure
placed on the ball of the foot.
When is
Surgery Needed?
When sesamoid injuries fail to respond to non-surgical treatment,
surgery may be required. The foot and ankle surgeon will determine the type of
procedure that is best suited to the individual patient.
Information provided by The American College of Foot and Ankle Surgeons