Common Foot Problems

Sesamoid Injuries in the Foot

A sesamoid is bone found inside a tendon that passes over a joint, found in several joints in the body. Sesamoids in the normal foot present as two pea-sharped bones embedded in the ball of the foot underneath the big toe joint.

The sesamoids act as a pulley for tendons that help to mobilize and leverage the big toe during walking and running. These bones also aid the first metatarsal bone – the long bone connected to the big toe joint – in absorbing the weight on the ball of the foot during walking, running and jumping.

Bones, tendons and even surrounding tissue in the big toe joint are often affected in sesamoid injuries. Sports such as baseball, basketball, football, golf and ballet that require increased pressure to the ball of the foot are associated with sesamoid injuries. People who often wear high heeled shoes, or have high arches may also be at increased risk for developing complications of the sesamoid bone.

There are three variances of sesamoiditis:

The first variance is turf toe, an injury to the soft tissue around the big toe joint. The big toe joint is usually injured when extended past the normal range, immediately causing sharp pain and swelling. Turf toe most often affects the entire joint and limits its range of motion. Possible outcomes of turf toe include a sesamoid fracture or an injury to the soft tissue attached to the sesamoid. Patients may feel a “pop” when injury occurs.

The second type is either an acute or chronic fracture in the sesamoid bone. An acute fracture results from trauma as a direct hit or impact to the bone. Patients will immediately feel pain and swelling at the injured area, not the entire big toe joint. A chronic sesamoid fracture is a stress fracture that normally results from repetitive stress or excessive use. This fracture is accompanied by longstanding intermittent pain in the ball of the foot, beneath the big toe joint. Pain is often worsened by physical activity and relieved with rest.

The third type of sesamoid injury is sesamoiditis, resulting from overuse of the sesamoid bone. Sesamoiditis is an outcome of increased pressure to the sesamoids, and presents with chronic inflammation of the sesamoid bones and tendons. Patients often experience longstanding, intermittent pain beneath the big toe joint, normally aggravated by wearing certain shoes and partaking in certain activities.

Dr. Radovic will examine the foot, focusing mostly on the big toe joint when diagnosing a sesamoid injury. As a part of the examination, Dr. Radovic will press on the big toe and test its mobility by moving it up and down. Dr. Radovic will evaluate walking patterns and wear patterns on the shoes. X-rays and

Sesamoid injuries of the foot can be treated with a combination of these non-surgical options. Non-surgical treatments may vary based on the type of injury and its level of severity:

Padding, strapping or taping may relieve the area of tension or inflammation. For example, a pad worn in the shoe would provide cushion to the inflamed sesamoids. Taping or strapping the toe can help relieve tension in the sesamoid area.

Immobilizing the foot in a cast or a removable walking cast may aid in healing of the injured sesamoid. Dr. Radovic may also recommend crutches to relieve weight from the foot.

Ibuprofen, aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation.

Physical therapy exercises and ultrasound therapy may be beneficial after a period of immobilization to strengthen, condition and increase range of motion of the sesamoid area.

Select cases may benefit from a cortisone injection in the joint to reduce pain and inflammation.

Custom orthotic inserts may be recommended as a long-term treatment for balance when walking and putting pressure on the ball of the foot.

Surgery may be necessary when patients are unresponsive to non-surgical treatment. Based on his evaluation, Dr. Radovic will determine the most suitable procedure on a case by case basis.

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