Sesamoid Disorders
Introduction
This is Patient Education Article – Sesamoid Disorders. It explains the basics of the pathology including signs, symptoms and basic treatment options.
Anatomy
Sesamoids are small bones located on the “ball of the foot” under the Big Toe. There are two sesamoids under each big toe. These bones function like a knee cap does in the knee. The sesamoids actually sit within one of the big toe tendons called the Flexor Hallucis Brevis. Sometimes sesamoid bones will be two pieces and appear as if they are
fractured – this is called a bipartite sesamoid. A bipartite sesamoid is normal between 7-30% of the population according to studies. In those people that have a bipartite sesamoid it is on both feet 80-90% of the time!
The sesamoids are important structures for the big toe because they absorb weight while walking, decrease the friction at the toe joint, and provide a fulcrum to help increase the mechanical force of the flexor tendon which generates more push off strength of the toe.
Sesamoid Disorders
There are several disorders or injuries that can occur at the sesamoids. They include:
- Fractures
- Sprains (Turf Toe)
- Sesamoiditis (Inflammation of the sesamoid complex)
- Dislocation (Traumatic or Degenerative)
- Arthritis
- Avascular Necrosis (Decreased blood flow to the sesamoids causing the bone to die)
- Painful & prominent Callus
Symptoms
These sesamoid disorders typically present with pain, swelling and difficulty with walking, especially during push off.
Diagnosis
The diagnosis of Sesamoiditis is usually very evident on clinical exam but distinguishing between the disorders often will require imaging such as x-rays, bone scans or an MRI.
Non-Surgical Treatment
The focus of treatment for sesamoid disorders is to take the pressure off the sesamoids and try to decrease the inflammation. This is accomplished by using the following:
- Walker Boot – Modifying activities and reducing the weight bearing on the ball of the foot helps relieve pain.
- NSAIDS – Anti-inflammatories like Ibuprofen or Naproxen will help decrease inflammation and pain.
- Orthotics – Custom orthotics with cushioning or padding will often be used to offload the ball of the foot and relieve pain.
Surgical Treatment
When conservative treatment fails to relieve pain and symptoms surgery is recommended. Sesamoid disorders can be treated with fracture fixation, ligament repair or sometimes by shaving down the bone or cutting out the sesamoid completely. Surgery will be determined based on your exact problem.
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