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Sesamoid Fractures

A sesamoid a bone within a tendon. Sesamoids exist in several joints, but the focus of these conditions is on the sesamoids found in the ball of foot before the big toe joint. These sesamoids are pea-shaped and function as pulleys to provide easier and smoother motion of the big toe. These sesamoids are essential because they bear a lot of the weight and forces running through the big toe and first metatarsal during physical activity. Sesamoid injuries revolve around the bones themselves, the surrounding tendon or neighboring tissues.

Common pathological conditions include:

• Turf toe: an injury resulting from overextending the big toe upwards and injuring the surrounding soft tissue.
• Fracture(s): a break of the sesamoid bone(s) usually due to acute trauma and repetitive overuse. The condition can be either acute or chronic. Chronic conditions are also known as stress fractures.
• Sesamoiditis: This a repetitive overuse injury targeting the tendon containing the sesamoids. Irritation and inflammation of the tendon causes excess pressure on the sesamoids causing local pain.

Symptoms:

These conditions due to all being local will result in similar symptoms.

• Pain, swelling and/or bruising in the forefoot before the big toe
• Increased pain during physical activity and walking
• Weakness in bending and extending the big toe
• Pain and discomfort is progressive over time

Diagnosis:

To confirm which condition to diagnose, the clinician will observe for tenderness, swelling, pain at different aspects of the sesamoid structure. The clinician will review the patient’s physical activity, medical history and perform a physical examination around the toe. X-rays and other imaging studies may also be ordered to evaluate which sesamoid is injured, if not both and for a possible cause.  

Treatment:

Treatment is conservative and is based on rest, orthotics, wearing modified shoes, modifying physical activity, NSAIDs, and taping of the big toe. Surgical means are an option if conservative options fail to return functionality of the toe and alleviate pain.

Sources:

https://footcaremd.org/conditions-treatments/toes/sesamoid-injuries 
https://www.foothealthfacts.org/conditions/sesamoid-injuries-in-the-foot 
https://orthoinfo.aaos.org/en/diseases--conditions/sesamoiditis/