Sesamoid Injuries of the Great Toe Joint

Spring is upon us, and choices of shoe gear change, as well as increased levels of outdoor weight-bearing activities, which can set us up for sesamoid injuries of the great toe joint.  Sesamoid injuries are common, but often overlooked injuries to the great toe joint.  Proper diagnosis and early treatment intervention is essential.  

Most people experience pain in their underlying great toe joint made worse with weight-bearing activity.

So what exactly are sesamoids?

Sesamoids are accessory bones found throughout the body.  They are found embedded in tendons and act as pulleys to increase the power and efficiency of those tendons and their neighboring joints. The kneecap is the largest sesamoid bone in the body and increases the strength of the quadriceps tendon during knee extension, enabling us to walk, jump and climb with greater power. In the foot, there are two sesamoid bones present in the flexor tendon beneath the great toe joint.  They are about the size and shape of peanuts. Their job is provide us with greater propulsion when walking, running and jumping.

Certain activities and biomechanical factors can contribute to sesamoid injuries.

  • High arches place more force on the heels and sesamoid bones.
  • Bunions change the weight bearing distribution on the sesamoid bones.
  • High heeled shoes.
  • Sports such as running, basketball, ballet, football and tennis.

What types of sesamoid injuries do we typically see?

  • Sesamoiditis:  This is an overuse injury of the sesamoid bones, caused by a repetitive bruising of the bones. The symptoms will quickly improve if the pressures on the sesamoids can be reduced.  
  • Fracture:  The fracture is often from a memorable event, but sometimes can result from prolonged overuse.  Unlike most bones, the sesamoid bones of the foot have poor blood supply leading to prolonging or non-healing.
  • Avascular necrosis:  Blood supply to the sesamoid bone is lost leading to degeneration and chronic pain.
  • Turf toe:  This is an acute hyperextension injury of the great toe joint seen in high energy sports such as football.  The ligaments and tendons around the sesamoids are strained.

Minor injuries, such as sesamoiditis may be managed simply with changes in shoe gear or custom orthotics, however, more serious injuries may require immobilization or even surgical intervention.

As with most injuries, proper and early diagnosis is essential.

– Lee Firestone, DPM

Dr. Firestone practices in the K Street NW (202-223-4616) and Chevy Chase (301-913-5225) locations.

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