Sesamoid Injury

ExitCare ImageSesamoid bones are bones that are completely enclosed by a tendon. The most recognizable sesamoid bone is the kneecap (patella). Your body also has sesamoid bones in the hands and feet. Sesamoid bones of the feet are more commonly injured than those of the hand. Sesamoid bones in the feet may be injured because of the force placed on them while standing, walking, running, or jumping. Sesamoid injuries include:

  • Inflammation of the sesamoid (sesamoiditis).

  • Fracture.

  • Stress fracture.

The sesamoid bone on the base of the big toe is especially susceptible.

SYMPTOMS

  • Pain with weight bearing on the foot, such as with standing, walking, running, jumping, or dancing.

  • Pain with trying to lift the big toe.

  • Tenderness and swelling under the base of the big toe.

CAUSES

A sesamoid injury is typically caused by acute trauma or overuse trauma to the foot. This may include jumping and landing on the ball of the foot or jumping or dancing on the balls of the feet. Other causes include:

  • Interrupted blood supply (avascular necrosis).

  • Infection.

RISK INCREASES WITH:

  • Sports that require jumping from a great height or repeated jumping or standing on the balls of the feet. These include:

  • Basketball.

  • Ballet.

  • Jogging.

  • Long-distance running.

  • Shoes that are too small or have very high heels.

  • Large or poorly shaped sesamoid bone.

  • Bunions.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain appropriate conditioning:

  • Ankle and leg flexibility.

  • Muscle strength and endurance.

  • Learn and use proper technique and have a coach correct improper technique.

  • Wear taping, protective strapping, bracing, or padding.

  • Wear shoes that are the proper size and ensure correct fit.

PROGNOSIS

If detected early and treated properly, sesamoid injuries are usually curable within 4 to 6 months.

RELATED COMPLICATIONS

  • Prolonged healing time if not appropriately treated or if not given enough time to heal.

  • Fracture does not heal (nonunion).

  • Prolonged disability.

  • Frequent recurrence of symptoms. Appropriately addressing the problem with rehabilitation decreases frequency of recurrence and optimizes healing time.

  • Arthritis of the joint between the sesamoid and the rest of the big toe.

  • Complications of surgery, including infection, bleeding, injury to nerves, continued pain, bunion or reverse bunion formation, toe weakness, and toe hyperextension.

TREATMENT

Treatment initially involves the use of ice and medication to reduce pain and inflammation. It may be recommended for you to modify your activities, so they do not cause an increase in the severity of symptoms. Depending on the severity of the injury, you may be required to use crutches in order to keep weight off of the injury. Padding, bracing, or taping the area may help reduce pain. Casting of the leg and foot, a walking boot, or a stiff-soled shoe (with or without an arch support) may also be helpful. For cases of chronic sesamoid symptoms, the use of physical therapy may be recommended. On occasion, corticosteroid injections are given to reduce inflammation. It is uncommon, but possible, for surgery to be necessary to remove the sesamoid bone.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen or other minor pain relievers such as acetaminophen are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given to reduce inflammation. However, these injections may only be given a certain number of times.

HEAT AND COLD

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 6 weeks despite treatment.

  • Any signs of infection develop, including fever, headaches, muscular aches and weakness, fatigue, redness, warmth, or increased swelling or pain.

  • Any of the following occur after surgery:

  • You experience pain, numbness, or coldness in the foot and ankle.

  • Blue, gray, or dark color appears in the toenails.

  • Signs of infection develop, including fever, increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects including bleeding, stomach upset, and allergic reactions).