Sesamoid injury is a relatively common cause of pain underneath the big toe joint, with pain when walking and running. It presents in various stages from irritation to fracture and can become arthritic.
So what are the sesamoids? The sesamoid bones are two small bones located on the underside, and just behind the big toe joint, they are approximately the size of kidney beans. Their function is to 1. help absorb shock during walking and 2. With their surrounding structures the assist mechanically in the push off phase of walking.
Symptoms: Typically patients describe a dull type pain when walking and during activity which involves loading the ball of the foot. Wearing specific shoes such as high heels or shoes which increased flexibility under the forefoot. As a result, this causes the structures around the sesamoid bones to be inflamed and irritated.
The most common cause is low-grade repetitive loading of the sesamoids. Which can be again from the prolonged use of heeled shoes or an unsupportive flexible shoe. High impact sports such as running on a hard surface. Dancers are particularly prone especially ballet dancers.
An injury such as landing heavily on the front of the foot.
Biomechanics and foot anatomy: All feet vary anatomically in length of bones, function, and shape, and hence loading patients will differ.
Bi-partite: meaning in 2 pieces it is a standard variant and has been reported in up to 33% of the population. Many patients present with their sesamoids be in 2 parts but no symptoms, this finding can get confused with a fracture.
Diagnosis is made by taking a clinical history taking, assessment and examination and is often combined with imaging which may include x-ray’s, ultrasound, or MRI depending upon clinical findings.
Once the diagnosis has been made treatment in the early stages is based around reducing the load from the painful site. The use of a trainer or supportive shoe for daily activity with the application of a cold compress or ice for 10mins daily and rest from high loading activity to alternative low impact activity.
An Insole or orthotic can be beneficial mainly to reduce the load through the sesamoids; a dancers pad is often incorporated. (see orthotics page for further details)
Some patients require a period or offloading into a boot followed with transition phase to trainers.
Surgery is occasionally required if conservative treatment has failed to resolve symptoms, this may be to remove of the affected bone.
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