Toe Conditions: Sesamoiditis / Sesamoid Fracture

Sesamoiditis and Sesamoid Fracture Causes

Sesamoiditis is typically caused by overuse and extra pressure. It can also be triggered by a hyper-extension injury of the big toe. Oftentimes, a stress fracture or full fracture can occur in the bone from overuse or a fall.

High heel shoes can also be a contributing factor because they stretch the flexor tendon, placing the sesamoids in a vulnerable and weight-bearing position under the foot.

These bones have a limited blood supply and are difficult to heal if not treated early. Without treatment, every step after the initial injury causes continued injury to the bone, leading to chronic pain and inflammation. Continued aggravation of the bone or extensive fracture causes the bone to lose its blood supply and die (avascular necrosis). Learn more about avascular necrosis here.

Most patients with a sesamoid fracture describe a deep achy or sharp pain in the ball of the foot behind the big toe with every step taken. In most patients, the pain subsides when the foot is at rest.

Sesamoiditis and Sesamoid Fracture Diagnosis

Clinical testing consists of noting the amount of pain experienced when the sesamoid bones are explored. This exam helps identify which of the two bones, or if both, is injured. Plain x-ray evaluation is used to determine the extent of the injury. An x-ray can also be used to determine that the sesamoids are in the correct position, directly under the metatarsal head. In some cases, an MRI is used to evaluate if the bone is viable, or if it has lost its blood supply.

Sesamoiditis Treatment Options

Conservative treatment

Conservative treatment consists of taking pressure off the foot in the area of the sesamoids. Initially, the doctor may recommend a period of immobility by placing the foot in a special boot to take the weight off the bones. Some patients with acute injuries may be required to use crutches. In addition, patients must rest their feet and use properly cushioned shoes. Exercise should be delayed during the healing process.

In some cases, cortisone injections are used to reduce inflammation around the bones. Physical therapy can bring increased circulation to the area and limit inflammation and pain over long the long term. Also, functional orthotics with special accommodation is used to take the pressure off the ball of the foot.

Surgical treatment

Sesamoiditis can usually be controlled and improved with conservative treatment. Surgery to remove all or part of the sesamoid is infrequently needed to treat this condition and only used when conservative treatments fail.

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Frequently Asked Questions about Sesamoiditis

 

Q. I was told I have sesamoiditis in my right foot about a year ago. We did the arch pad sleeve and the insole taping. I have stopped running completely, modified exercises so I don’t stretch that big toe much (no lunges and similar exercises). But with all of the padding and support, modifications to my exercise routines, ibuprofen, and ice and rest my foot still hurts. What options remain for such a chronic issue that will ease the pain and allow me more freedom in my daily life and the ability to perform regular exercises again?

 

A. Here are a few things you can consider:

1) Orthotic with cutout region
2) Stiff soles shoes to avoid bend in the toe
3) Possibly removal of sesamoid if damaged

 

 

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