X-ray of the foot

The sesamoids are two pea-shaped bones found in the ball of the foot, underneath the big toe joint. These small bones have two big jobs to do.

  • First, they act as pulleys for your tendons, helping the big toe move normally and providing leverage when you push off to walk or run.
  • Second, they help the long bone in your big toe absorb the weight placed on the ball of the foot during physical activity.

Causes

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. It's commonly associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. But in addition, sesamoiditis can occur in women who wear high-heeled shoes, hikers who wear heeled boots, in people who walk barefoot or wear thin-soled shoes, or in those who have a high-arched foot.

Symptoms

  • Pain under the big toe or on the ball of the foot.
  • Swelling and bruising.
  • Difficulty and pain in bending and straightening the big toe.

Surgery is usually not required to treat sesamoiditis.

Diagnosis

In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.

Treatments

Non-surgical

  • Discontinue the activity causing the pain and inflammation.
  • Ice the sole of the foot.
  • Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
  • Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. Note: Please consult your physician before taking any medications.
  • Injection of a steroidal medication to reduce swelling.
  • Custom orthotics may be needed for long-term treatment of this condition.
  • Physical therapy can help during the rehabilitation period of this injury. Range-of-motion and strengthening exercises are usually employed and ultrasound therapy.
  • Wear shoes with cushioning that are soft-soled and low-heeled to relieve stress on the foot.

If symptoms persist, you may need to wear a removable brace on the leg for 4-6 weeks to give the inflammation time to subside and the bones to heal.

Surgical

When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

Other Sesamoid Injuries of the Foot

Turf toe 

This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Football players, soccer players, dancers, and gymnasts are most at risk for this injury. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Sometimes a “pop” is felt at the moment of injury. 

Sesamoid Fracture

A fracture (break) in a sesamoid bone can be either acute or chronic.

An acute fracture is caused by trauma – a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint.

A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.

Learn about other types of sports injuries here.

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