While most bones in the body are connected to each other by joints, few bones are not connected to any other bone; but rather, are connected exclusively by tendons or are embedded in muscle. These types of bones are classified as sesamoids. The kneecap is the largest sesamoid in the human body. Two very small sesamoids are found in the underside of forefoot, near the big toe – one on the outer side of the foot and the other close to the middle of the foot.
Sesamoids act as pulleys by providing a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the big toe. However, very much like other bones, sesamoids can fracture as well. This can cause the surrounding tendons to become irritated or inflamed – resulting in sesamoiditis. Sesamoiditis is a form of tendinitis and is common amount dancers, runners, and sports players.
- Pain is focused under the great toe on the ball of the foot. With sesamoiditis, pain may develop gradually; with a fracture, pain will be immediate.
- Swelling and bruising may or may not be present.
- You may experience difficulty and pain in bending and straightening the great toe.
During examination your Chiropodist will examine the foot and the sesamoids. They can then determine what treatment option is best for you.
Treatment is generally non-operative and your Chiropodist can usually help. Only in extreme cases, would it result in a referral to a surgeon for further measures.
- Stop the activity causing the pain.
- Take aspirin or ibuprofen to relieve the pain.
- Rest and ice the sole of your feet. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.
- Wear soft-soled, low-heeled shoes. Stiff-soled shoes like clogs may also be comfortable.
- Use a felt cushioning pad to relieve stress.
- Your chiropodist might recommend a certain type of custom orthotic to displace force on bones
- Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities that put your weight on the balls of the feet.
- Tape the great toe so that it remains bent slightly downward (plantar flexion)..
- If symptoms persist, you may need to wear a removable short leg fracture brace for 4 to 6 weeks.
Fracture of the Sesamoid
- You will need to wear a stiff-soled shoe or a short, leg-fracture brace.
- You may have to wear a J-shaped pad around the area of the sesamoid to relieve pressure as the fracture heals.
- It may take several months for the discomfort to subside.
- Cushioning pads or other orthotic devices are often helpful as the fracture heals.