Sesamoid Injuries in the Foot

What is a Sesamoid?
SesamoidA 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.
    • Sesamoid2An 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.


Trauma & Injuries


Urgent Access & Walk-in Hours

FAAWC understands the challenge of finding foot and ankle care that is quickly accessible. That's why we offer emergency/urgent appointments on an as-needed basis. Please call 740-363-4373 for availability. From noon to 3 p.m. Fridays, FAAWC is open for ANY walk-in patients who do not have a scheduled appointment.


Dr. Anderson: Foot and Ankle Trauma

Sports Injuries Many sports are hard on the feet because of quick and repetitive movements, constricting footwear and/or increased exposure to injury or trauma.

Shin Splints Pain on either side of the leg bone that is caused by muscle or tendon inflammation.

Broken Ankle Can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.

Ankle Sprains Caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle.

Stress Fractures Incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization.

Chronic Lateral Ankle Pain Recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.

Osteochondritis (stiff ankle) A lesion that usually causes pain and stiffness of the ankle joint and affects all age groups. Osteochondritis is caused by a twisting-type injury to the ankle.

Osteochondromas Benign bone tumors that form in the bone beneath the toenail. Osteochrondromas account for about half of all benign bone tumors, and they occur mostly in children and young adults.

Learn more about selecting the proper athletic shoes with our athletic shoe guidelines.