Sesamoid Stress Fractures: A Complete Overview
Oct 28 , 2021
Tags : Sesamoid Stress Fractures
Before we dive into the specifics of sesamoid stress fractures, it’s important to understand what sesamoids actually are.
Simply put, sesamoids are the bones embedded in a tendon, and can be found in several joints in the body.
In a “normal” foot, the sesamoids are two pea-shaped bones that are located in the ball of the foot underneath the big toe.
Essentially, the sesamoids act as a pulley for tendons, helping the big toe to move around and provide leverage when pushing off the ground during walking and running.
Plus, sesamoids also serve as a weight bearing surface for the first metatarsal bone (the long bone connecting to the big toe), and absorb the weight placed on the ball of the foot during activity.
More often, sesamoid injuries are associated with activities that demand great pressure on the ball of the foot such as basketball, football, tennis, running and dance. This is due to repetitive use in the same position, which can lead to inflammation and fractures.
Types of Sesamoid Injuries
There are three types of sesamoid injuries in the foot:
1) Fracture
A fracture (break) in a sesamoid bone can be either acute or chronic. An acute fracture occurs due to trauma - a direct blow to the bone, and presents immediate pain and swelling. However, it will not affect the entire big toe. A chronic fracture is a stress fracture (due to repetitive movement and overuse), and produces long standing pain in the ball of the foot beneath the big toe. With chronic fractures, the pain can come and go and is usually apparent during activity and relieved during rest.
2) Turf Toe
Turf toe is an injury to the soft tissue surrounding the big toe joint, and immediately causes sharp pains and swelling. Typically, this occurs when the big toe has been extended beyond its normal range of motion, and the pain will affect the entire toe, limiting its motion.
3) Sesamoiditis
Sesamoiditis is an overuse injury that involves chronic inflammation inside the sesamoid bones and tendons, and is usually caused by an increase in pressure placed around the sesamoids.
In terms of pain, it’s commonly reported as a dull, long-standing pain underneath the big toe. It can come and go, but is normally aggravated when wearing certain shoes or taking part in certain activities.
Symptoms
If you have a sesamoid stress fracture, you will feel pain underneath the big toe on the ball of your foot.
With sesamoiditis, the pain can develop over a period of time, whereas with a fracture, this will be almost immediate.
Sometimes, you may experience a degree of swelling and bruising.
Lastly, you may find it difficult to walk as it feels uncomfortable and painful to bend and straighten the big toe.
Treatment
Treatment for sesamoid stress fractures are usually non-surgical, but this means it can take longer for the symptoms to fully resolve.
Only if and when conservertive measures fail, your doctor may recommend surgery to remove the sesamoid bone - but this is in extreme circumstances.
Typically, treatment will involve the following:
- Stopping activities that cause pain
- Taking pain killers, such as ibuprofen for pain relief
- Resting and icing the sole of your foot
- Wearing soft, low-heeled shoes to relieve pressure under the sesamoids
- Using cushioned pads around the sesamoid to relieve stress
- Taping the big toe so it remains slightly bent downwards
- Returning to activity slowly and avoiding those that puts weight on the balls of your feet
In rare cases, a steroid injection may be recommended. But, this should never be injected through the thickened, fat pad at the bottom of your foot as this could result in loss of the body’s normal fatty cushion.
If after following these steps your symptoms still persist, you may be required to wear a short leg fracture brace or cast for up to 6 weeks.
Unfortunately, healing of the sesamoid is quite slow and can take up to 6 months to fully heal.
Prevention
The best way to prevent another injury in your sesamoid is to make sure that your big toe is as flexible and as strong as it can be before you begin any repetitive movements, such as running or jumping in sports.
Simply, by allowing your sesamoid to heal properly, the risk of reinjuring it is small.
So only return back to your normal activities once the pain has completely gone away.
Plus, you should increase your activity level gradually, otherwise your symptoms can flare up again.
In addition, you should wear proper footwear, designed for specific activities, which can help protect your feet from any abnormal strain in your big toe joint.
As such, avoid wearing old, worn out shoes, or shoes that have high heels as this will add extra pressure on the ball of your foot.
Depending on your foot shape, you may be advised to wear custom orthotics that can decrease the strain in your foot, and minimise the impact between your foot and the ground.
For more information get in touch.
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