Sesamoid injury is a 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.
The sesamoid bones are two small bones located on the underside, and just behind the big toe joint. They are roughly the size of kidney beans.
Their function is to:
1. Help absorb shock during walking and,
2. With their surrounding structures, they assist mechanically in the push off phase of walking.
Patients typically describe a dull type of pain when walking and during activity which involves loading the ball of the foot. Wearing certain 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.
Diagnosis is made by taking a clinical history, assessment and examination. This 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.
Rest from high loading activity to alternative low impact activity.
An Insole or orthosis can be beneficial mainly to reduce the load through the sesamoids; a dancers pad is often incorporated. (see orthoses 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 the affected bone.
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