SESAMOID INJURIES IN THE FOOT

What is a Sesamoid? absorbing the weight placed on the break, but usually does not affect sesamoid is a bone embedded ball of the foot when walking, the entire big toe joint. A in a tendon. Sesamoids are running, and jumping. A chronic fracture is a stress found in several joints in the body. Sesamoid injuries—which can fracture—a hairline break usually In the foot, the sesamoids are two involve the bones, tendons, and/or caused by repetitive stress or pea-shaped bones located in the ball surrounding tissue in the joint—are overuse. A chronic sesamoid of the foot, beneath the big toe joint. often associated with activities fracture produces longstanding requiring increased pressure on the pain in the ball of the foot ball of the foot, such as running, beneath the big toe joint. The basketball, football, golf, tennis, and pain, which tends to come and go, ballet. In addition, people with high generally is aggravated with

Sesamoid arches are at risk for developing activity and relieved with rest. bones sesamoid problems. Frequently • Sesamoiditis. This is an overuse wearing high-heeled shoes can also injury involving chronic be a contributing factor. inflammation of the sesamoid bones and the tendons involved Types of Sesamoid with those bones. Sesamoiditis Injuries in the Foot is caused by increased pressure There are three types of sesamoid to the sesamoids. Often, injuries in the foot: sesamoiditis is associated with Sesamoid bones are located • Turf toe. This is an injury of the a dull, longstanding pain beneath the big toe joint. soft tissue surrounding the big toe beneath the big toe joint. The joint. It usually occurs when the pain comes and goes, usually big toe joint is extended beyond occurring with certain shoes its normal range. Turf toe causes or certain activities. immediate, sharp pain and swelling. It usually affects the Diagnosis entire big toe joint and limits the In diagnosing a sesamoid injury, Sesamoid bone motion of the toe. Sometimes a the foot and ankle surgeon will “pop” is felt at the moment of examine the foot, focusing on the injury. big toe joint. The surgeon will press Acting as a pulley for tendons, the • Fracture. A fracture (break) in a on the big toe, move it up and sesamoids help the big toe move sesamoid bone can be either acute down, and may assess the patient’s normally and provide leverage when or chronic. walking and evaluate the wear the big toe “pushes off” during An acute fracture is caused by pattern on the patient’s shoes. X-rays walking and running. The sesamoids trauma—a direct blow or impact to are ordered, and in some cases, also serve as a weightbearing surface the bone. An acute sesamoid additional imaging studies—such for the first metatarsal bone (the long fracture produces immediate pain as a bone scan or MRI—may also bone connected to the big toe), and swelling at the site of the be needed. Treatment: Non-Surgical used to prevent placing weight • Orthotic devices. Custom orthotic Approaches on the foot. devices that fit into the shoe may Non-surgical treatment for sesamoid • Oral medications. Nonsteroidal be prescribed for long-term injuries of the foot may include one anti-inflammatory drugs treatment of sesamoiditis to or more of the following options, (NSAIDs), such as ibuprofen, are balance the pressure placed on depending on the type of injury and often helpful in reducing the pain the ball of the foot. degree of severity: and inflammation. • Padding, strapping, or taping. • Physical therapy. Sometimes the When is Surgery Needed? A pad may be placed in the shoe rehabilitation period following Surgery is generally reserved for the to cushion the inflamed sesamoid immobilization includes physical most severe sesamoid injuries which area, or the toe may be taped therapy,such as exercises fail to respond to non-surgical or strapped to relieve that area (range-of-motion, strengthening, treatment over a long period of time. of tension. and conditioning) and ultrasound In these cases, the foot and ankle • Immobilization and non- therapy. surgeon will determine the type of weightbearing. The foot may be • Steroid injections. In some cases, procedure that is best suited to the placed in a cast or removable cortisone is injected in the joint to individual patient. L walking cast. Crutches may be reduce pain and inflammation.

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This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 6,200 foot and ankle surgeons. Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2007,American College of Foot and Ankle Surgeons • www.FootPhysicians.com