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Forefoot Injuries INJURIES

Sesamoid Fractures- Causes, Symptoms & Treatment

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Sesamoid fractures have a significant impact on a person’s mobility and quality of life. This article delves into what sesamoid breaks are, what causes them, and how to recognize their symptoms. 

Readers will gain an understanding of the diagnostic process, encompassing both physical examination and advanced imaging techniques. 

The article outlines various treatment strategies, from non-invasive to surgical, providing insight into the recovery process for each. 

sesamoid bones on xray

What Is a Sesamoid Fracture?

A sesamoid fracture is an injury that occurs in one of the two pea-sized bones located at the bottom of the first metatarsal head near the great toe joint (metatarsophalangeal joint). 

Injuries to these small but crucial bones constitute around 12% of all injuries to the big toe complex. 

The sesamoid bones, known as the tibial sesamoid and fibular sesamoids, develop fully by the age of 12 and are vital in absorbing shock, supporting weight, and protecting the first metatarsal during walking and standing.

The medial sesamoid is larger and bears more weight, making it more susceptible to fractures.

These unique bones are embedded within the flexor hallucis brevis tendons, which assist in toe movement, specifically downward flexion of the big toe.

pressure on ball of feet

What Causes a Sesamoid Fracture?

A sesamoid fracture results from repetitive stress, traumatic incidents such as falls or accidents, or specific movements that cause the toe to flex upward, due to the sesamoid’s position on the foot’s ball.

High-impact activities like dancing, running, and gymnastics often apply excessive pressure on this area, leading to a higher incidence of sesamoid injuries, as noted in a study by C. Stein in The Physician and Sports Medicine journal.

Sports that demand swift acceleration, deceleration, and pivoting, like soccer and football, can cause these fractures.

A person’s individual foot structure contributes to the likelihood of developing sesamoid breaks. 

For instance, those with high-arched feet are at an increased risk due to the elevated stress experienced underneath the forefoot. 

Symptoms

Recognizing the symptoms of a sesamoid injury is crucial. These fractures present a distinct set of signs, causing discomfort in the foot. 

You may experience: 

  • Pain and swelling localized at the bottom of the forefoot that radiates into the arch
  • Bruising
  • Pain that intensifies when bearing weight on the forefoot
  • Persistent pain even while at rest (unlike with sesamoiditis)
  • Pain that is noticeable when flexing the big toe upwards and downwards
  • Limping may be present (especially in children)
ct scan sesamoids

Diagnosis

The diagnosis of a sesamoid injury is achieved through a combination of physical examination and imaging procedures. If you suspect you have a sesamoid injury, see a Podiatrist or a Foot and Ankle Orthopaedic surgeon. 

During the exam, the foot and ankle surgeon will palpate (touch) the area around the tibial and fibular sesamoids to assess pain and swelling.

Then, your doctor will order radiographic images of your foot, including an axial sesamoid x-ray, to get a clear view of the sesamoid bone and search for the fracture.

If the x-ray doesn’t show the fractures clearly, an ultrasound may be ordered to diagnose the fractures. In cases where diagnosis is difficult, advanced imaging techniques like an Magnetic Resonance Imaging test (MRI) or a Computed Tomography scan (CT scan) may be ordered. 

An MRI allows for detailed visualization of the soft tissues surrounding the sesamoid bones, which aids in excluding other potential injuries such as sesamoiditis (inflammation of the sesamoid bones).

A CT scan provides an in-depth look at the sesamoid bones themselves, helping to identify the fracture pattern and the number of fracture lines. This information is important if surgery is required.

female wearing cast boot

How Are Sesamoid Injuries Treated?

The treatment of a fractured sesamoid bone in the foot depends on the nature and severity of the fracture.

For a simple fracture where the foot bone fragments are aligned, you will need to keep weight off the foot in a cast boot for at least 6-8 weeks, allowing the fracture to heal. 

This would be followed by a gradual return to weight-bearing over another 3-4 weeks in the cast boot, before moving back to regular athletic shoes. 

Fracture healing in the foot would be monitored via x-rays every 3-4 weeks. 

You should also perform RICE (Rest, Ice, Compression, Elevation) therapy to alleviate pain and swelling. 

Your doctor will recommend orthotics with sesamoid pads in them to offload the ball of the foot. This will help prevent re-injury.

On the other hand, if the fracture is complex and the fragments are not aligned or are shattered, surgery may be necessary. 

The procedure involves repositioning the bone fragments and using small screws for fixation. Sometimes a bone graft may be added to aid healing due to the poor blood supply in the foot sesamoid bone. 

After surgery, you would follow a similar recovery path of non-weight bearing and gradual return to weight-bearing.

In cases where the fracture results in many small pieces, the sesamoid may be completely removed from the foot, followed by a recovery process similar to the surgical repair. 

However, it’s important to understand that if a sesamoid bone in the foot is removed, there will be less power when pushing off with your toe while walking and running. 

Also, this procedure could potentially cause changes to the shape or structure of your foot over time.

How Much Does Sesamoid Surgery Cost?

According to MDSave.com, the cost of sesamoid bone removal from the foot is $5866 on average. You will need to call your insurance company to see if the surgery would be covered or not.

What Happens if These fractures Goes Untreated?

If a sesamoid break is left untreated, it can cause chronic pain and post-traumatic arthritis in the great toe. 

You may feel pain when you walk and put pressure on the ball of the foot. This can make high-impact activities like sports difficult to complete due to pain. 

Is Shockwave Therapy Effective for Sesamoid Bone Injuries?

Shockwave therapy, a non-invasive procedure that sends acoustic waves to an injured area, is being increasingly recognized as an effective treatment for foot injuries. It works to stimulate the body’s own healing mechanisms and can lead to substantial pain relief and enhanced mobility. However, its effectiveness in healing sesamoid fractures has yet to be studied. 

Conclusion

In conclusion, sesamoid breaks, though small in nature, have a significant impact on mobility and overall quality of life. This article has shed light on the causes, symptoms, and treatment options, emphasizing the critical role of sports medicine and orthopedic services. 

Whether through non-invasive treatment  or surgical intervention, a hospital with an MD Foot and Ankle specialist or Podiatrist can provide essential care to patients suffering from these fractures. Moreover, addressing such injuries promptly can prevent chronic pain and post-traumatic arthritis in the joint, ensuring you can return to your daily activities and sports as soon as possible. 

With the right care, the complications of sesamoid breaks can be effectively managed, helping patients to reclaim their mobility and quality of life.

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Related articles: 

Cuboid Fractures of the Foot- A Helpful Guide

Navicular Foot Fractures- A Helpful Guide

Plantar Plate Tears- Causes, Symptoms & Treatment

References

  1. Mittlmeier T, Haar P. Sesamoid and toe fractures. Injury. 2004 Sep;35 Suppl 2:SB87-97
  2. Sims, A. L., & Kurup, H. V. (2014). Painful sesamoid of the great toe. World journal of orthopedics, 5(2), 146
  3. McBryde AM Jr, Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med. 1988 Jan;7(1):51-60.
  4. Stein CJ, Sugimoto D, Slick NR, Lanois CJ, Dahlberg BW, Zwicker RL, Micheli LJ. Hallux sesamoid fractures in young athletes. Phys Sportsmed. 2019 Nov;47(4):441-447.
  5. Bronner, S., Novella, T., & Becica, L. (2007). Management of a delayed union sesamoid fracture in a dancer. journal of orthopaedic & sports physical therapy, 37(9), 529-540
  6. Blundell, C. M., Nicholson, P., & Blackney, M. W. (2002). Percutaneous screw fixation for fractures of the sesamoid bones of the hallux. The Journal of Bone and Joint Surgery. British volume, 84(8), 1138-1141.
  7. Daddimani RM, Madhavamurthy SK, Jeevannavar SS, Shettar CM. Fracture of the medial tibial sesamoid bone of the foot-case report. J Clin Diagn Res. 2015 Apr;9(4):RD03-4.
  8. Stracciolini A, Dahlberg BW, Quinn B, Sugimoto D, Stein C. SESAMOID INJURIES IN PEDIATRIC AND ADOLESCENT ATHLETES PRESENTING TO SPORTS MEDICINE CLINIC. Orthopaedic Journal of Sports Medicine. 2019;7(3_suppl).

DISCLAIMER: The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition or treatment before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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