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Sesamoid Injuries

What the heck is a sesamoid? Are they normal? Why do I have two bean shaped bones under my big toe joint? All common questions. Every patient who looks at they foot x-rays for the first time asks what the sesamoids are. For the context of this discussion, the sesamoids are two small bones inside the flexor tendon on the bottom of the big toe joint. These act as a pulley for the tendons and allow your big toe to push off with more force. They also help to absorb the force of walking and running on the underside of the first metatarsal (the long bone connected to your big toe).

In a word, sesamoid injuries hurt! The little bones you didn’t even know were there are an integral part of being able to walk, so when they are injured you have trouble bending and pushing off with your big toe joint.

How do we injure our sesamoids? Any activity that puts a lot of pressure on the ball of the foot can injure the sesamoids. This includes running, tennis, football, dance, and golf to name a few. High-arched feet and high-heeled shoes as well as flip-flops can make you more susceptible to sesamoid injuries.

The symptoms of sesamoid injuries include pain in the ball of your foot, pain when bending the big toe joint, swelling, and sometimes popping or crunching of the joint.

Diagnosis is made by physical examination, x-rays and sometime a bone scan or MRI. Sesamoid injuries can be to the soft tissues, known as "turf toe" or to the bones themselves, which usually have a traumatic or stress fracture.

Treatment includes immobilization, shoe gear modification, an orthotic device to control the abnormal biomechanics, padding, anti-inflammatories or injection therapy to decrease inflammation, and if chronic or fractured, surgery.

When is surgery needed for sesamoid injuries? When the sesamoid is broken in a million pieces or if you have pain every day, in every pair of shoes you own (including your athletic shoes) and you have treated your condition with conservative therapy without any relief; it’s time to discuss sesamoid surgery. Surgery should never be contemplated without pain and activity limitations.

Discuss your options with your doctor if your pain is not going away with conservative therapy. There have been a significant advancement in the treatment of sesamoid injuries in the last few year, so don’t give up and try to live with chronic pain. Seek help today!