• Sesamoid Fracture

    Definition

    A sesamoid is a type of bone that is found within a tendon. Sesamoid fractures most commonly refer to the bones located under the big toe. These small bones allow smooth movement of the feet. These are the least common fractures of the forefoot.
    Sesamoid Bones of the Foot
    sesamoid bone foot
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Sesamoid fractures can be caused by:
      Injuries, particularly:
      • Falling from a height and landing heavily on the feet
      • Crush injury
    • Repetitive stress to the bone
    • Hyperextension of the toe and forefoot

    Risk Factors

    These factors increase your chance of a sesamoid fracture. Tell your doctor if you have any of these risk factors:
      Participation in high-impact sports
      • Running
      • Aerobics
      • Ballet
      • Basketball
      • Gymnastics

    Symptoms

    The most common symptom of a sesamoid fracture is pain in the ball of the foot and big toe. Other symptoms include:
    • Swelling to foot and big toe
    • Bruising
    • Tenderness to touch
    • Limited range of motion to the big toe

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor may refer you to a specialist. A podiatrist focuses on the feet. An orthopedist focuses on bones.
    Tests may include the following:
    • X-ray of the foot—test that uses radiation to take a picture; used to detect breaks in the bone
    An x-ray may not be able to provide enough detail of the small bone. In this case you may need:

    Treatment

    Sesamoid fractures are most often treated with rest and rehabilitation. Talk with your doctor about the best plan for you. Treatment options include the following:

    Immobilization

    The foot is immobilized with a cast. This will promote healing and keep weight off the foot. Crutches are also used to limit weight bearing on the affected foot.
    The foot is immobilized with a cast. This will promote healing and keep weight off the foot. Crutches are also used to limit weight bearing on the affected foot.

    Medications

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are given to reduce pain and swelling. A cortisone shot may also be used to treat the pain and inflammation.

    Physical Therapy

    Once the cast is removed, physical therapy may be advised. A therapist will work with you to strengthen your muscles and improve your range of motion. You may be given an orthotic device or insert to wear in your shoe. This can protect your foot from future injury.

    Surgery

    Surgery is rarely needed. However, if the pain does not resolve, the sesamoid bone is sometimes removed. This is called a sesamoidectomy.

    Prevention

    To help reduce your chance of fracturing your sesamoid bone:

    RESOURCES

    American College of Foot and Ankle Surgeons http://www.footphysicians.com/

    American Podiatric Medical Association http://www.apma.org/

    CANADIAN RESOURCES

    The Canadian Orthopaedic Foot & Ankle Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Foot and Ankle Injuries. American Podiatric Medical Association website. Available at: http://www.apma.org/s%5Fapma/doc.asp?CID=371&DID=9412 . Accessed October 23, 2008.

    Mandracchia VJ, et al. Fractures of the Forefoot. Clinics in Podiatric Medicine and Surgery . 2006;23(2).

    Maskill JD. First Ray Injuries. Foot and Ankle Clinics . 2006;11(1).

    Sesamoid Injuries in the Foot. American College of Foot and Ankle Surgeons website. Available at: http://www.footphysicians.com/footankleinfo/Sesamoid%5FInjuries.htm . Accessed October 23, 2008.

    Sesamoiditis. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00164 . Accessed October 27, 2008.

    Sesamoiditis/Sesamoid Fractures. Podiatry channel website. Available at: http://www.podiatrychannel.com/sesamoiditis/index.shtml . Accessed October 23, 2008.

    Revision Information

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