Sesamoid Injuries

Sesamoids are bones contained within tendons; the sesamoids in the foot are located just under the big toe joint. These bones are crucial both for assisting the tendons during movement and for bearing the weight associated with activities like walking, jumping and sprinting. This makes the foot sesamoids particularly prone to injury in many types of athlete.

Varieties of Injury

The foot sesamoids can become damaged alone or in conjunction with the surrounding tendons or tissue depending on the circumstances of the injury. Three types of sesamoid condition are common. Sesamoiditis involves ongoing swelling both to the tendons and the bone, while fractures tend only to affect the bone. The third sesamoid condition is turf toe, discussed in detail in another article on this website; it affects the tissue around the big toe joint, mostly following hyperextension of the big toe. Two prominent risk factors for sustaining any sesamoid injury are continually wearing unsuitable shoes, and biomechanical errors such as high arches.

Sesamoid Fracture

Fractures are often caused by harsh trauma to the area. Such impacts can arise from a falling accident in sports like cycling or horse riding, or due to a blow from a projectile or fellow athlete in a contact sport. Regular fractures come in two forms. Acute fractures will be painful and lead to inflammation but they are unlikely to cause damage to the entire joint. A chronic fracture, however, is generally more serious and will greatly reduce your ability to participate in sports activities. Stress fractures (see our corresponding article) are of the chronic variety, and this type of injury to a sesamoid is provoked by overuse, i.e. due to repetitive excessive strain, or training with weakened leg muscles. It is characterised by erratic pain which is worsened with exercise and eased by resting.

Sesamoiditis

Sesamoiditis is caused through repeatedly placing extreme pressure on the joint, which can occur in regular activities such as running and walking if you do not take sufficient breaks, warm up correctly, or if you overexert yourself in a damaging way. The injury strikes the affected sesamoid and tendon, leading to inflammation in both. The other primary symptom is a near chronic aching where the big toe meets the base of the foot. This pain may be more pronounced when performing certain activities, particularly those involving an aspect of pushing off (e.g. sprinting, jumping; playing basketball, tennis or football) because this movement relies on bending and putting pressure on the big toe. Tight, thin or badly fitted shoes can also worsen the pain.

Treatment

A doctor will recommend appropriate treatment depending on the severity of the injury. Methods often implemented include taping or strapping the area, fitting a cast to allow unimpeded healing, or using shoe orthotics to correct any biomechanical foot problems. During treatment you might be prescribed anti-inflammatory medication to relieve pain and swelling. Following successful healing, a program of physical therapy will help to gradually build up your activity level and restore strength to relatively unused muscles. In severe cases, or if a sesamoid injury does not recover following non-surgical measures, surgery may be necessary.