All About Sesamoid Injuries

July 20, 2011 Posted by Dr.Chang


From a dull aches to sharp throbs, foot pain in the joint just below the big toe, known in medicine as the first metatarsal-phalangeal joint (1st MTPJ), is no fun. It is not surprising that your 1st MTPJ feels sore or injured since the balls of your feet take a pounding with each step. Researchers estimate that the front of your foot absorbs three to four times your body weight with each stride as you run. With an average of 1500 strides per mile, runners and athletes can put considerable stress on their feet. Moreover, feet have complex structures, each containing 26 bones, 33 joints, 112 ligaments, not to mention the additional tendons, nerves and blood vessels. With such a complex machine as the foot, it is often difficult for foot doctors to diagnose and treat 1st MTPJ injuries, and almost impossible to provide one uniform treatment plan for injuries to this area. This blog post addresses one type of 1st MTPJ injury, injuries to small bones in the 1st MTPJ called sesamoids, which effect a large number of runners and athletes of all ages and ability levels.

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 dorsi flexion, 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.

But with more elements that make up the foot’s anatomy, there is more opportunity for injury. All athletes are susceptible to sesamoid injuries, especially athletes who put more pressure on the balls of their feet such as runners, tennis players, soccer players, football players and dancers. Children can have injuries to their sesamoids especially because of torsion or trauma in impact sports. Those of us with high arches put a lot of pressure on the MTP joints, and can therefore damage the sesamoids. Other factors that contribute to sesamoid injuries include wearing high heels or other tight shoes (like pointe shoes for ballet or climbing shoes), and traumatic injuries to the front of the foot.

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.

Self-diagnosis and treatment is neither reliable nor advisable for sesamoid injuries. As previously mentioned, sesamoid injuries are often tricky to diagnose even with xrays and MRIs. Their size and position within the tendons of your feet makes it difficult to see injuries to the bones. On top of their small size, varied foot morphology and injury pathology will significantly alter treatment programs. Be sure to make an appointment Dr. Chang and Dr. Murray to have your injury diagnosed and to receive a recommended treatment plan sooner rather than later.

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.

Don’t let your injury get to this point if you can prevent it! Preventing injuries to the sesamoid bones requires employing a range of good judgment. Be sure you have a proper training program. For all athletes, this includes warming up, stretching, and not overdoing it. For runners, stick to a 10% maximum increase in mileage per week – any more will likely result in injury. For runners or other athletes who tend to pound, stomp, or make a lot of noise when their feet hit the ground, it’s advisable to slow down. Find a pace that is pound free and stick to it for a while, trying to speed up gradually while maintaining a softer stride.

If you are anxious before beginning a training program because of previous injuries or other concerns, consulting your podiatrist before starting could be helpful. Podiatrists may provide helpful input, and suggest ways to factor your foot structure, foot function, and body type into your training program.

Most importantly, proper shoes and orthotics can be lifesavers for preventing injuries. Visit Dr. Murray and Dr. Chang for advice on over the counter and custom orthotics. Various shoe and running stores around Charlottesville and Waynesboro, including Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes will provide expert shoe advice by evaluating the way your foot is structured and how it moves moves, and matching your individual needs and concerns to an appropriate shoe.

Be good to your feet when they’re hurting. Visit your podiatrist in Charlottesville or Waynesboro for a diagnosis and integrated treatment plan for sesamoid injuries. Be sure you are wearing shoes with stiff toe boxes that do not cramp your foot. And finally, allow your injury the time and conditions it needs to heal.

Comment on this post to share your sesamoid injury story or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

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