Sesamoid injuries usually occur as a result of sports and other high impact activities. The sesamoid bones are two pea shaped bones that sit under the base of the big toe.
The sesamoid bones sit encased in the flexor hallucis brevis tendon that assists toe mobility and the transfer of weight from foot to floor during activity.
The big toe joint area absorbs significant force during high impact or weight bearing activities such as running, jumping and hiking.
Given the enormous pressures applied to the sesamoid bones, it’s hardly surprising that sesamoid injuries occur so frequently.
What Is It, What Causes It?
A stress fracture can occur in the sesamoid bone as a result of a direct blow or repetitive stress. Because the sesamoid bones are very small, an acute sesamoid fracture can occur quite easily.
In these sesamoid injuries, the medial sesamoid (or tibial sesamoid) bone may potentially fracture into several parts.
Jumping, hopping or any activity that delivers a high strike force to the entire big toe joint are typical causes of sesamoid injuries.
Sesamoid injuries may also occur as a result of repetitive activities that place too much pressure on the ball of the foot. Sometimes a sesamoid injury occurs as a result of a hyperextension injury of the big toe.
You may also be more prone to suffering a sesamoid injury if you have feet with high arches.
This is because the shape of the foot transfers the force to the outside of the foot and places greater stress on the sesamoid bone, ball of the foot and the entire big toe joint.
The fact that bipartite medial sesamoid formations can also occur naturally may complicate diagnosis of the problem.
Diagnosis by an experienced podiatrist will quickly identify whether you’re dealing with an acute fracture or an inflamed sesamoid area or more chronic inflammation of the soft tissue attached to the bone.
Ultrasound imaging can help confirm the podiatrist’s diagnosis.
What are the Symptoms?
Sharp pain throughout the big toe joint and sometimes spreading into the ball of the foot is a typical sign of a sesamoid fracture or sesamoid injury.
You might experience a sharp pain on applying an explosive pressure to the ball of the foot, such as when jumping or suddenly sprinting.
Typically, the pain will worsen as you continue with that particular movement but you may also experience longstanding pain beneath the big toe joint for some time afterwards.
You may also find yourself trying to favour that part of your foot in an effort to reduce the pain.
What’s The Best Treatment?
Proper diagnosis of all sesamoid injuries is pivotal to delivering the best recovery outcome. Rest, ice, compression are helpful first aid steps but for rapid recovery and to avoid a recurrence of the problem you really need to see an experienced podiatrist.
Nonsteroidal anti inflammatory drugs can help reduce the pain and swelling in the inflamed big toe joint area.
In the case of a fractured sesamoid, immobilisation of the foot may be necessary for a few weeks in a removable walking cast or air cast.
Additional dense foam rubber cushioning under the big toe can help offload weight from the forefoot and relieve pressure on the ball of the foot.
We may recommend custom orthotics if analysis shows that your gait or other mechanical misalignment is applying significant pressure on the big toe and triggering sesamoid injuries.
Custom orthotics not only remove the pressure on the big toe and ball of the foot but enable your feet, ankles, knees and legs to function as they were designed to do for optimal mechanical advantage.
Erica Dash podiatrists may also recommend shockwave therapy or dry needling services to speed your recovery.
These gentle healing therapies help to stimulate the body’s natural healing processes, increase blood circulation, and reduce bruising, inflammation, and recovery time.
If you don’t seek treatment for a sesamoid stress fracture it can degenerate into a much more serious condition known as avascular necrosis.
Avascular necrosis (bone death) will usually require surgical intervention to alleviate the pain and ongoing problems.
Erica Dash podiatry, our friendly expert and experienced staff are here to help you get back on your feet again as quickly as possible.
If you are experiencing discomfort or restricted movement anywhere around the ball of the foot, then pop in and see us.
Shockwave is a great alternative to treatments such as dry needling if you’re needle phobic and not keen on dry needling. We also have effective treatment offers for kids.