Sesamoid Fracture

Pain from a sesamoid injury is focused under the big toe on the ball of the foot. With sesamoiditis or a stress fracture, pain may develop gradually, whereas with a fracture, the pain will be immediate after trauma. Swelling and bruising may or may not be present. There may be difficulty and pain when bending and straightening the big toe.

Sesamoids act like pulleys, increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weight bearing and help elevate the bones of the big toe. Like other bones, sesamoids can break in a traumatic injury. They also can develop a stress fracture from overuse. In addition, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis or tendinosis. It is common among ballet dancers, runners, and professional athletes.

During your examination, your doctor will look for tenderness at the sesamoid bones. Your doctor may manipulate the bone slightly or ask you to bend and straighten the toe. He or she also may bend the big toe up toward the top of the foot to see if the pain intensifies.

Treatment for sesamoiditis usually is nonoperative and successful, but can be frustrating in how long it takes for symptoms to resolve. If conservative measures fail, your physician may recommend surgery to remove the sesamoid bone. First, your specialist will recommend the following:

• Stop the activity that causes the pain.
• Take acetaminophen or ibuprofen to relieve the pain.
• Rest and ice the sole of your foot. Do not apply ice directly to the skin; use an ice pack or wrap the ice in a towel.
• Wear soft-soled, low-heeled shoes. Stiff-soled shoes also may be comfortable, but be aware that clogs (like Dansko) elevate the heel and put more pressure under the sesamoids, so they should be avoided.
• Use a felt cushioning pad around the sesamoid to relieve stress.
• Return to activity gradually and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet (the elliptical machine and stairclimber are both performed with weight placed through the forefoot).
• Tape the big toe so that it remains bent slightly downward.

Watch this video to learn about how sesamoid injuries occur.

Numerous factors contribute to the development of sesamoiditis, and most of them are not preventable. People with high foot arches, flat feet or those who run on the ball of their foot may be more prone to sesamoiditis. Wearing cushioned and protective shoes can help distribute pressure across your foot. If this is a recurrent problem, a gait analysis can assess if the foot is putting too much pressure.