What is a Sesamoid Fracture?
A sesamoid fracture is a break in the sesamoid bone. Sesamoids are two small, pea-shaped bones located in the ball beneath the big toe joint at the bottom of the foot. Sesamoid bones are connected to muscles and other bones by tendons that envelop these bones. Sesamoids help the big toe move normally and absorb the weight placed on the ball. A fellowship trained, foot and ankle orthopaedic surgeon such as Dr. Damien Richardson, MD, MPH is a doctor specializing in the treatment of foot and ankle problems including sesamoid fractures.
Symptoms
Pain in the ball of the foot and the big toe is the most common symptom. You may also experience bruising, swelling, tenderness, and limited range of motion.
Causes
A direct blow, trauma or landing on your foot incorrectly while playing sports can cause acute fractures. Chronic fractures are tiny hairline cracks in the bone, most often caused due to repeated stress. Sesamoid fractures are common in people involved in running, ballet dancing, aerobics, and high-impact sports like basketball.
What Happens if a Sesamoid Fracture is Left Untreated?
One or both of the sesamoid bones lie near the first metatarsophalangeal (MTP) joint. Untreated sesamoid fractures can cause cartilage problems and arthritis of the MTP joint.
Diagnosis
Dr. Richardson will assess your symptoms and take a medical history. Physical examination of the foot will be performed by moving your big toe. Your walking pattern will also be analyzed. Imaging studies such as X-ray, MRI or CT-scan will be ordered to confirm the diagnosis.
Treatment
Your treatment plan may include:
- Immobilization: Controlled Ankle Motion (CAM) boots, post-operative stiff sandals or shoes, and even splints may be applied to keep the toe in a fixed position.
- Rest: Adequate rest can heal a sesamoid fracture.
- Orthotics: Custom medical devices of the foot such as foot inserts that keep the great toe straight and pads are prescribed to cushion the inflamed toe and relieve pressure.
- Medications: A combination of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids may be used to manage pain and inflammation.
- Ice pack: Ice packs applied over a towel to the injury will help reduce swelling and pain.
- Elevation: Keeping your foot elevated above the heart level can reduce pain and inflammation.
- Physical Therapy: Regular exercise regimen to improve range of motion and strengthen the big toe once healing has been deemed sufficient by your orthopaedic surgeon
Surgery is recommended if you do not respond to non-surgical treatment options.
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