Sesamoid Injuries in the Foot
Sesamoid bones are 2 small bones embedded in the tendon on the underside of the ball of each foot, by the big toe joint. The bones assist with the movement of the big toe, and provide a weight bearing surface for absorption of impact. Sesamoid injuries can involve the bones, tendons, or the surrounding soft tissues in the joint. Activities such as running, basketball, football, golf, tennis, and ballet place increased force on the sesamoids, leading to higher chance of sesamoid injuries. Wearing high-heeled shoes can also be a contributing factor, since the majority of the weight is placed at the forefoot.
Types:
Turf Toe: This type of injury results from damage done to the soft tissue surrounding the big toe joint, when the joint is extended beyond the normal range. Turf toe can also result in soft tissue damages that are attached to the sesamoids or as a result of fracture of the sesamoid bones. For more information, please refer to Turf Toe.
Fracture: An acute fracture in the sesamoid bones can be caused by direct trauma to the sesamoid bones. This type of fracture results in acute pain at the site, with immediate swelling. Repetitive impact, such as running, can cause stress fractures of the sesamoid bones. This type of fracture presents with long standing pain that tends to come and go.
Sesamoiditis: This is an overuse injury causing chronic inflammation of the sesamoid bones, and the surrounding tendons. This is caused by increased pressure at the site. The pain comes and goes, usually aggravated with certain shoes or activities.
Diagnosis:
A thorough history with physical examination on the big toe joint can identify the issue. A biomechanical examination can also help assess the gait pattern which contributes to the condition. To assess the integrity of the sesamoid bone, an X-ray can be ordered. In cases in which the symptoms do not improve accordingly, advanced imaging can be considered.
Treatment:
Conservative treatment can include the following:
Surgery can be considered if a patient fails conservative treatment.
Sesamoid bones are 2 small bones embedded in the tendon on the underside of the ball of each foot, by the big toe joint. The bones assist with the movement of the big toe, and provide a weight bearing surface for absorption of impact. Sesamoid injuries can involve the bones, tendons, or the surrounding soft tissues in the joint. Activities such as running, basketball, football, golf, tennis, and ballet place increased force on the sesamoids, leading to higher chance of sesamoid injuries. Wearing high-heeled shoes can also be a contributing factor, since the majority of the weight is placed at the forefoot.
Types:
Turf Toe: This type of injury results from damage done to the soft tissue surrounding the big toe joint, when the joint is extended beyond the normal range. Turf toe can also result in soft tissue damages that are attached to the sesamoids or as a result of fracture of the sesamoid bones. For more information, please refer to Turf Toe.
Fracture: An acute fracture in the sesamoid bones can be caused by direct trauma to the sesamoid bones. This type of fracture results in acute pain at the site, with immediate swelling. Repetitive impact, such as running, can cause stress fractures of the sesamoid bones. This type of fracture presents with long standing pain that tends to come and go.
Sesamoiditis: This is an overuse injury causing chronic inflammation of the sesamoid bones, and the surrounding tendons. This is caused by increased pressure at the site. The pain comes and goes, usually aggravated with certain shoes or activities.
Diagnosis:
A thorough history with physical examination on the big toe joint can identify the issue. A biomechanical examination can also help assess the gait pattern which contributes to the condition. To assess the integrity of the sesamoid bone, an X-ray can be ordered. In cases in which the symptoms do not improve accordingly, advanced imaging can be considered.
Treatment:
Conservative treatment can include the following:
- 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 into 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.
Surgery can be considered if a patient fails conservative treatment.