What is a Sesamoid?
Doctor, why do I have this nagging pain underneath my big toe joint?
Have you ever heard of a Sesamoid injury? Let’s take a closer look at this problem.
Let’s start at the beginning… What exactly are sesamoids?
A sesamoid is a bone embedded in the tendons that course below your big toe joint. Sesamoids are found in several joints in the body. Your kneecap, or patella, is another example. Acting as a fulcrum point, 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 the weight-bearing interface for the first metatarsal bone. As such, they absorb the weight placed on the ball of the foot in motion. Sesamoid injuries encompass a variety of disorders involving tendons, bones, ligaments and/or surrounding tissues.
Who is most likely to get an injury to the sesamoid complex of the foot?
Sesamoid injuries often are associated with activities that tend toward increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. Repetitive use in the same position (loading the big toe joint) can lead to inflammation and even fractures. People with high arches are also at risk for developing sesamoid injuries.
The three types of sesamoid injuries in the foot:
- 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 or traction forces around the sesamoids. Sesamoiditis is commonly reported as a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.
- 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 long standing 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.
- Turf toe: This is an injury of the soft tissue surrounding the big toe joint. Turf toe causes immediate, sharp pain and swelling. It usually occurs when the big toe joint is extended beyond its normal range. It usually affects the entire big toe joint and limits the motion of the toe.
What should I do if I think I have sesamoid problems?
If you have pain, swelling, or bruising below the big toe joint, it may be a sesamoid issue. It all begins with a test. The x-ray is the most common and widely used first diagnostic test for this injury. During an exam, your foot and ankle doctor will examine the foot, focusing on the big toe joint. Your doctor will press all around the big toe, move it up and down. Your walking may also be assessed.
How is a sesamoid injury treated?
At-home remedies can include wearing stiffer shoes, icing the area, and avoiding wearing heels. In most cases, at FASMA, our podiatrists will recommend a non-surgical treatment for sesamoid injuries to be first attempted. Depending on your doctor’s exam this may include: Immobilization, oral nonsteroidal anti-inflammatory drugs (NSAIDs), orthotic devices, physical therapy, and padding, strapping, or taping
When sesamoid injuries fail to respond to non-surgical treatment, steroid injections or surgery may be required. Your foot and ankle surgeon will determine the type of procedure that is best suited to your individual needs.
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