Embedded inside the tendons that connect your big toe to the rest of your foot are two pea-sized bones called sesamoids. These two bones, the tibular and fibular sesamoids, act as pulleys and assist the propulsion of the big toe. As your toe moves up, they allow for dorsiflexion, and as your toe moves down they allow for plantar flexion. The sesamoids are parts of a fascinating system that assist in absorbing the weight put on the ball of the foot and propelling the foot forward. Without them, we wouldn’t be able to run.
Sesamoid bones, like other bones, can be dislocated, sprained and fractured. There are a few common types of sesamoid injuries. Turf toe is an injury of the soft tissue surrounding the big toe joint and the sesamoid bones, and could even be a fracture of the sesamoid. It usually occurs when the big toe is extended beyond its normal range. Turf toe is a traumatic injury – with this injury you’ll feel a sharp pain immediately, your MTP joint will swell, you might even hear a popping noise during impact and your range of motion will probably be limited after the injury. Breaking a sesamoid bone (known as an acute fracture) is a traumatic injury, with similar immediate symptoms to turf toe (immediate pain and swelling), but may not disrupt the range of motion in your big toe. A stress fracture (otherwise known as a chronic fracture) is usually an overuse or repetitive motion injury. The pain will probably come and go with a stress fracture. Another common overuse injury to the sesamoid bones is known as sesamoiditis. Due to inflammation of the sesamoid bones and their surrounding tendons, the sesamoid bones can be put under an increasing amount of pressure resulting in a dull pain under the 1st MTPJ. With sesamoiditis you may find that the pain worsens when you wear certain shoes or do certain activities.
Dr. Chang and Dr. Murray can help tailor the right treatment program for your sesamoid injury. Treatment will most likely be varied, and may include padding, strapping or taping the big toe and 1st MTPJ. It may be important to immobilize the joint, especially in the case of fractures, in order to allow proper and expedited healing. Rest, elevation, ice, ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) will help reduce the swelling (whenever taking NSAIDs for a prolonged period be sure to drink lots of water to flush them through your system). In order to increase the blood flow to the area for healing, physical therapy, including range of motion exercises and stretches, may be prescribed.
It is critical to consider the environment in which you keep your feet during and following a treatment plan. Both over-the-counter and custom orthotics can help with healing and injury prevention. New shoes with rocker soles or a stiff forefoot will help you both during exercise and throughout the rest of the day. Remember that your feet are always absorbing impact, even when you are not exercising. Especially with sesamoid injuries, it is highly advisable to avoid cheap and unsupportive shoes or flip flops even outside of exercise. Finally, when you are injured or in pain, being tough means having the patience to give your injury time to heal. When you take time off and allow your body to recover, you’ll be able to get back to your favorite activity sooner and at a higher level. When non-invasive treatments do not work, your podiatrist may suggest a range of options for foot surgery. Be sure to discuss these various options with your podiatrist.