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Sesamoid Fracture

  • Definition

    A sesamoid is a type of bone that is found within a tendon. These small bones allow smooth movement of the feet. Sesamoid fractures most commonly refer to the bones located under the big toe. 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

    Sesamoid fractures are more common in people who play high-impact sports, such as running, aerobics, ballet, or 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.
    Imaging tests evaluate the bones and other structures in your foot. These include:
  • Treatment

    Sesamoid fractures are 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.
    Surgery
    Surgery may be needed if the fracture is severe or not healing.
    • This is usually done by setting the bone during an operation.
    • If the pain does not resolve, the sesamoid bone is sometimes removed. This is called a sesamoidectomy.
    Physical Therapy
    Once the fracture has healed, 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.
  • Prevention

    To help reduce your chance a sesamoid fracture, wear proper fitting footwear for all activities and sports.
  • RESOURCES

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

    Foot Health Facts—American College of Foot and Ankle Surgeons http://www.foothealthfacts.org

    CANADIAN RESOURCES

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

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

    References

    Sprains, strains, and fractures. American Podiatric Medical Association website. Available at: http://www.apma.org/learn/FootHealth.cfm?ItemNumber=982. Accessed September 28, 2014.

    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 Foot Health Facts website. Available at: http://www.foothealthfacts.org/footankleinfo/Sesamoid%5FInjuries.htm. Accessed September 28, 2014.

    Sesamoiditis. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00164. Updated September 2012. Updated September 28, 2014.

    Sesamoiditis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 16, 2014. Accessed September 28, 2014.

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

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