What Are Sesamoids?
Sesamoids are small bones that are embedded in a joint capsule or tendon. We have them throughout our bodies, including in our hands, wrists, knees, and feet. Sesamoids of the feet are small bones located in the ball of the foot, running underneath the first metatarsal. When you walk, the sesamoids help the smaller muscles in the ball of the foot to firmly place the big toe onto the ground. Without them, we wouldn’t be able to bear enough weight on the foot to push off during sports and activities.
Not only can a sesamoid injury prevent an athlete from doing what they love, but it is also very painful. Sesamoid injuries are common among runners, dancers, and skilled-position football players.
Causes and Types of Sesamoid Injuries
There are various types of sesamoid injuries in the feet. These include:
- Turf toe. When the soft tissue surrounding the big toe joint is extended beyond its normal range, it becomes injured. Turf toe is immediately painful, with sharp pain and swelling. It may result in injury to the soft tissue attached to the sesamoid, as well as potentially a fracture to the sesamoid.
- Acute fracture. Caused by a direct blow to the bone, an acute fracture causes immediate pain and swelling at the sesamoid but doesn’t affect the entire big toe joint.
- Chronic fracture. This is a stress fracture, usually caused by repetitive stress or overuse.
- Sesamoiditis. This is an overuse injury that brings chronic inflammation of the sesamoid bones and tendons. Sesamoiditis causes dull pain that ebbs and flows with certain shoes and activities.
- Avascular necrosis. This can develop in one or both sesamoids. It occurs when the blood flow to the bone has been disrupted, causing the bone to essentially die.
- Arthritis. Arthritis affecting the sesamoid is fairly common. This degenerative process happens when the bone cartilage starts to wear down. Bones start to rub against each other, causing chronic pain and swelling.
Sesamoid injuries can be caused by activities that put increased pressure on the ball of the foot, including running, basketball, football, tennis, and ballet. Frequently wearing high-heeled shoes can also cause issues.
How a Podiatrist Can Help
If you think you might have a sesamoid injury, it is important to reach out to a podiatrist right away to prevent further injury or complications. There are a few different options for those struggling with sesamoid injuries, and your treatment plan will be determined by the type of injury you have, as well as its severity.
If you have sesamoiditis, some of your options for recovery include:
- Icing the injury
- Wearing soft-soled, low-heeled shoes
- Taping or bracing the foot
- Steroid injection therapy
For a sesamoid fracture, non-surgical options include:
- Wearing stiff-soled shoes or a short leg fracture brace
- Taping the injury
- Using a “dancer’s pad,” which is a J-shaped sesamoid pad
- Custom orthotic devices
Unfortunately, sometimes surgery is necessary. Sesamoiditis is usually not responsive to surgery and will not be an option. But surgery can help with fractures. The podiatrist will go in and repair the bone or sometimes remove one of the sesamoids. Both are rarely removed, as this will cause permanent damage to the foot and restrict the range of motion.
Under general anesthesia, the surgeon will make a small incision underneath the foot. They will move surrounding tissue aside and remove the sesamoid, and/or repair the bone. The incision will then be closed, and the patient can usually go home within a few hours. It takes approximately six months to regain full range of motion and see the benefit of surgery.
We Are Proud to Help Recreational & Competetive Athletes
At InStride Carolina Podiatry Group, our podiatrists interact with athletes regularly, and sesamoid injuries are a common occurrence. Our experience and care for each patient individually can bring relief and healing to active people struggling with chronic pain. Contact our Lancaster office at 803-285-1411, or visit our website to reach out or view a list of all our office locations.