Archive for the ‘Sesamoid Injury’ Category

What is a Sesamoid Injury?

June 17th, 2015 by Blue Ridge Foot and Ankle

Sesamoid Injuries

Perhaps you have never heard of a sesamoid, but at Blue Ridge Foot & Ankle Clinic we see many people who are experiencing foot pain as a result of sports and leisure activities that put pressure on the ball of the foot, such as basketball, running, football, golf, tennis, or ballet, which can result in a sesamoid injury.

What are Sesamoids?

A sesamoid is a bone embedded in a tendon. In the foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint. Sesamoids act as a pulley for the tendons, helping the big toe move normally and also providing necessary leverage for the big toe when it pushes off during walking and running. These sesamoids are also the weight-bearing surface for the long bone connected to the big toe, called the metatarsal bone.

Sesamoid Injuries

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. There are three main kinds of sesamoid injuries:

  • Turf Toe: This injury of the soft tissue surrounding the big toe joint usually occurs when the big toe is extended beyond its normal range. You may feel a “pop” at the moment of injury and will usually feel a sharp pain, followed by swelling.
  • Fracture: A break in a sesamoid bone can either be acute–caused by a trauma or impact to the bone–which results in immediate pain and swelling at the site of the break; or chronic–due to repetitive stress or overuse–which is characterized by ongoing pain that increases with activity and is relieved with rest.
  • Sesamoiditis: This injury is a chronic inflammation of the sesamoid bones and tendons that is usually caused by overuse and activities that put increased pressure on the sesamoids. Its symptoms are a dull, longstanding pain beneath the big toe joint that usually worsens with particular activities or certain shoes.

Diagnosis and Treatment

Our board certified foot and ankle surgeons, Dr. Stewart M. Chang and Dr. Kevin P. Murray are experts in the central VA area in diagnosing sports related injuries. After a thorough examination of the foot and big toe area, the doctor may evaluate your walking and the wear pattern of your shoes. Digital x-rays, which can be done in either our Charlottesville or Fishersville office, may also be ordered. Once the diagnosis is confirmed, there are a variety of non-surgical treatments available, with surgery reserved for those people who do not respond to those treatments.

If you suspect you may have a sesamoid injury, contact one of our offices today to make an appointment.

Women athletes, especially those who run and do triathlons, are often told that they are more susceptible to certain lower extremity pain. But what are the unique qualities of the female physique and subsequent common injuries? This post will discuss lower extremity pain common among women due to musculo-skeletal characteristics, hormonal changes and even cultural factors. Below you will also find a few simple suggestions for reducing the risk of foot and ankle injuries. However, Ladies, injuries are cause by a variety of factors and treated in a variety of ways depending on your individual body type and list of activities. If you are experiencing foot and ankle pain, never hesitate to consult your local Charlottesville podiatrist for more information.

Female Musculo-Skeletal Factors in Injuries

There are a few factors that doctors consider when discussing female-specific injuries. Foremost, the angle that represents the relationship between the pelvis, leg and foot, referred to as the Q angle, is more dramatic in females because of women’s wider hips. Knowing this angle is important for athletes because repetitive and continual stress throughout the lower back, pelvis, hip, knee and ankle will often produce injuries in the lower part of the body, especially among women with wider Q angles. Determining whether your Q angle falls outside of the normal range may help in considering the causes of foot and ankle pain, not to mention pain in the lower back, pelvis and even the neck.  If you are concerned that your Q angle is affecting your running or causing foot and ankle pain, visit Dr. Murray and Dr. Chang for a professional assessment. They will be able to provide various suggestions, including fitting you with over the counter and custom orthotics.

Common running injuries due to a wide Q angle include patellofemoral pain syndrome or runner’s knee, iliotibial (IT) band syndrome, and shin splints. Women commonly feel pain from patellofemoral pain syndrome, otherwise known as runner’s knee, behind or around the kneecap. Runner’s knee has a range of causes – from over use, direct trauma or misalignment to flat feet. Women commonly are afflicted by runners knee due to a weak VMO muscle (vastus medialis oblique <<image>>), a muscle in the interior thigh. The good news is that it is easy to strengthen the VMO through knee extension and hip abduction exercises. Contact your Charlottesville or Waynesboro podiatrist to find the right exercise plan for you.

Iliotibial band syndrome is also a common injury found among female runners and triathletes. The IT band is made up of tissue that runs on the outside of the thigh, from the pelvis to just below the knee. While crucial to stability during activity, its continual abrasion against the top of the femur and the knee can make it inflamed, causing pain in the hip, thigh and/or knee. Often, using a foam roller can help runners prevent and heal sore IT bands. Stretching is a great preventative measure for IT band pain. Try standing straight up, and bending to the side as far down as is comfortable. Two sets of 15 repetitions on each side should work wonders. Hip flexor exercises can do the trick as well. Kneel on one knee and turn the torso until you feel a stretch on the IT band. Hold this for 5-10 seconds, and repeat 3 times on each side. Again, consult Dr. Murray and Dr. Chang or another licensed professional to design the appropriate workout for you.

Shin splints, known to doctors as medial tibial stress syndrome (MTSS), result from too much force on the shinbone and the connective tissue attaching muscles to it. If you run, chances are that you’ve had the ‘splints. Studies show that up to 15% of running injuries are shin splints, and the advertisements in the back of running magazines are certainly a good testament to that fact. Shin splints are common among runners who have flat feet or over-pronate. In other cases they are caused by tightness in other various muscles and tendons (another good incentive to warming up and stretch!) and by increasing mileage too quickly. Try your best not to increase mileage more than 10% per week; especially with the female disposition to have diminished bone density, female runners are up to 3.5 times more likely than men to contract stress fractures from shin splints.

By far, the single most important to preventing shin splints, along with all of the Q-angle injuries mentioned above, is wearing properly fitted shoes and being attentive to when your shoes are worn out. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.

Age and Hormone-Related Causes of Injuries

The female Q angle can take tolls on knees, ankles and feet of all ages. High school athletes have a high incidence of injuries to the ligaments in the knees, primarily the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), because they tend to lack the lateral stability and endurance necessary for optimal performance and injury prevention. Some experts write that 30% of all ACL tears occur among high school females due to the Q-Angle of the female hip. Some helpful tips for ACL/MCL injury prevention among teens include not neglecting a 5-10 minute warm up, followed by stretching, planning for rest, and staying hydrated. High school athletes can also benefit from light to moderate lateral plyometrics such as lunges and squats, and even light weight lifting.

Female-specific hormones may have great effect on female runners throughout their lives. Hormones, such as relaxin, that women release during pregnancy lead to the relaxation of ligaments. Biologically, this allows for smoother births, but these hormones can affect ligaments in the feet, leading to arch pain, collapsed arches, plantar fasciitis and over pronation. While the jury is still out on the benefits of running during pregnancy, most experts agree that easy running in moderation can be helpful for second trimester moms who are runners, as long as it is balanced with enough time resting the feet and attentiveness to overheating and hear rate levels. Consult your obstetrician to determine a proper exercise routine during your pregnancy.

Not surprisingly, pregnancy may necessitate larger shoe sizes due to swelling. Ligament laxity may permanently increase shoe sizes or altered foot shape. Cramming a new foot size into old shoes too often results in foot and ankle pain. Contact your local shoe experts to determine whether your shoe size has changed, and what the best new fit might be – your feet are worth it!

And what about running injuries during menopause? The experts are still out on whether running correlates to an easier ride through menopause. However, the precaution about menopause often is that diminishing bone density resulting from hormonal changes can often lead to osteoporosis. Boosting the amount of calcium in your diet to between 1000-1500 mg before menopause is a good preventative measure to ward off post-menopausal osteoporosis, especially for female runners. Keeping running and strength training up can keep your bones strong, help prevent bone fractures and healthy circulation, not to mention running’s other physical and emotional benefits!

Other Causes of Female Injuries

In addition to biology, nurture, or cultural influences, may be factors in female injuries as well. High heels often lead to bunions, hammertoe, ingrown toenails, sesamoid injuries, Morton’s Neuroma, back pain and other problems. Remember that good-looking shoes are not exclusive of comfort. Consider buying shoes with arch support and room in the toe box from stores like Richey and Co. Shoes.

But high heels are not the only culprits of foot and ankle pain! If your running or athletic shoes do not fit or are worn out, you can likely injure your legs, ankles or feet. Be attentive to the wear in your shoes, and buy new athletic shoes frequently – according to your podiatric experts, Dr. Murray and Dr. Chang, the appropriate shoes will prevent a host of injuries!

Unfortunately, female athletes are particularly susceptible to eating disorders, and what doctors have come to know as the “Female Athlete Triad.” The triad is made up of an eating disorder and weight loss, amenorrhea (missed periods), and osteoporosis. Poor nutrition can lead to bone loss, decreased serum estrogen levels, psychological abnormalities, and, in extreme cases, death. Those who suffer from the Female Athlete Triad may experience fatigue, anemia, depression, decreased concentration, constipation, cold intolerance, and parotid gland enlargement seen in the cheeks. If this isn’t bad enough, the boneless can cause stress fractures that will not heal without proper nutrition and self-care.

Nurture your body! Healthy eating leads to strong bones and can keep you strong, fit and running your best. Balanced and healthy diets improve athletic performance, prevent osteoporosis, and aid in the healing of injuries. Consuming a target of 1000 mg of calcium per day, with sufficient Vitamin D for calcium absorption (which can either be derived from sunlight or regulated supplements), will help prevent stress fractures. Visit our page on bone healing for more information.

So, to all the female runners out there, stay strong and inspired, and remember that consulting your doctor, fully understanding the various causes of injuries and taking care of yourself will aid in injury prevention and healing.

Comment on this post to share your thoughts 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.


All About Sesamoid Injuries

July 20th, 2011 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.



To request an appointment, please fill out the form below. Our scheduling coordinator will contact you to confirm your appointment.


Join Our Mailing List:

Enter your E-mail in the box below:

Our Affiliations

Monticello Community Surgery Center

Augusta Health

Martha Jefferson