Introduction
The sesamoids are two small bones located at the base of the big toe. They play a vital role in weight-bearing and act as pulleys that facilitate the movement of the big toe during walking. Repeated pressure, force, or tension can lead to sesamoiditis, which is an inflammatory condition. If the force is excessive, it can result in a fracture of the sesamoid bones. Most individuals with either sesamoiditis or a sesamoid fracture tend to heal effectively with non-surgical interventions.
Anatomy
The sesamoids are small bones situated at the joint where the big toe meets the foot's sole. These bones rest within grooves and are stabilized by a triangular ligament. They create a pulley system, known as the sesamoid apparatus, which assists the muscles in lowering the toe during walking. Additionally, they work in conjunction with the big toe to absorb the forces generated while walking.
Causes
Sesamoiditis and sesamoid fractures often arise from significant, repetitive stress on the ball of the foot. Athletes, particularly ballet dancers and baseball catchers, are at higher risk. However, these conditions can also result from consistent pressure from regular walking or a sudden force, such as a fall or a high-impact jump.
Symptoms
Symptoms of sesamoiditis usually develop gradually and worsen over time. Patients may feel increasing pain beneath the big toe and in the ball of the foot, which can worsen with movement. Bending or straightening the big toe and walking may become difficult. Redness and swelling may also occur.
In contrast, a sesamoid fracture typically presents with immediate pain, often accompanied by a large bruise beneath the toe. Swelling in the forefoot may hinder the ability to bend the toes or walk.
Diagnosis
A podiatrist can diagnose sesamoiditis or fractures by assessing the patient's medical history and examining the foot. It's important to inform the doctor of any relevant activities, falls, or accidents. X-rays or bone scans may be used to confirm the presence of a fracture.
Treatment
Most cases of sesamoiditis and fractures can be managed without surgery. Treatment options include rest, over-the-counter pain relief, and ice to alleviate pain and swelling. Low-heeled shoes are recommended, and specific footwear or padding may be suggested to minimize pressure. Taping or strapping may help restrict movement of the big toe during the healing process.
For severe sesamoiditis, steroid injections may be administered to reduce inflammation. In some instances, crutches and a short leg fracture brace or walking cast may be necessary for several weeks. Fractures typically require immobilization and non-weight bearing for six to eight weeks.
Surgery
Surgery for sesamoid fractures is rare but may be required if conservative treatments do not alleviate symptoms. A sesamoidectomy, which involves the removal of the sesamoid bone, can be performed, though it may weaken the toe joint and increase the risk of bunions.
Recovery
Recovery varies based on the severity of the condition, whether it is a fracture or sesamoiditis, and the treatment provided. Your podiatrist will guide you on what to expect during the recovery process.
