Symptoms and Treatment of Sesamoid Injuries

Man Holding His Foot While in PainPain in the ball of your foot can make it challenging to run, walk, or even stand for long periods—especially if you’ve injured your sesamoid bones. These two pea-shaped bones lie beneath the big toe joint, anchoring the tendons and bearing the weight and stress of each step you take. Overuse, sudden trauma to the foot, or sports injuries can strain or fracture the sesamoids, severely limiting your mobility and jeopardizing your athletic career.

Types and Causes of Sesamoid Injuries

Sesamoid injuries can involve the bones themselves but also the tendons and tissues in the big toe joint. Running, football, tennis, basketball, and ballet dancing are typical causes due to the repeated pressure these activities place on the ball of the foot. High arches, a sudden “pushing off” the big toe, or landing from a jump can place a patient at increased risk for sesamoid problems.

There are many kinds of sesamoid injuries, including:

  • Turf toe. Turf toe, or overextension of the big toe joint, is the most common injury affecting the sesamoids. It was named after many football players who suffered the condition after repeatedly crouching and pushing off the ground on the balls of their feet. A hyperextended toe joint can stretch the ligaments to the point where they need surgical repair.
  • Sesamoiditis. Sesamoiditis is an inflammation of the tendons surrounding the sesamoid bones. Unlike other bones in the body, the sesamoids aren’t attached to other bones. Instead, they’re embedded in the tendons in the ball of the foot. The bones can become inflamed along with the tendons, making the ball of the foot extremely painful. Any repetitive movements that transfer weight to the ball of the foot can result in sesamoiditis, including wearing high heels.
  • Fractures. The sesamoid bones may be small, but they can still break if placed under enough pressure. A direct impact to the bone—such as falling onto the ball of the foot from an extreme height—could result in an acute fracture causing immediate pain and swelling at the site of the break. In contrast, repetitive stress can cause tiny cracks in the bones (known as stress fractures) that can cause chronic pain and inflammation throughout the ball of the foot.
  • Arthritis. Arthritis in the big toe joint is common in patients who have previously suffered a bunion or other injury in the ball of the foot. As the cartilage in the joint starts to wear down, the sesamoid bones begin to rub against each other and cause debilitating pain. If anti-inflammatory medications or orthotics aren’t enough to relieve the pain, a patient may need surgery to remove one or both sesamoids.
  • Avascular necrosis. Avascular necrosis occurs when the blood supply to one or both sesamoid bones has been cut off. If the bones cannot get oxygen and nutrients, they will begin to break down, causing severe pain in the ball of the foot. A podiatrist can determine whether the bone has died and whether surgery will be necessary to remove the sesamoids and restore mobility.

Successful Treatment for a Sesamoid Injury

Rest can relieve many symptoms of a sesamoid injury, especially those caused by repetitive strain. Ice and elevation can also help reduce inflammation and encourage healing. In more severe cases, the toe may require:

  • Padding. The big toe may be taped in place or padded to relieve tension.
  • Immobilization. Sesamoid fractures may require an air cast or boot to take the weight off the affected foot.
  • Orthotics. Patients may need custom orthotic devices to cushion the inflamed sesamoid area and ease pressure on the ball of the foot.
  • Surgery. Removal of the sesamoid bones is usually only done as a last resort, but minor procedures may be performed to remove fragments from a fracture.

Let Our Podiatry Team Advise You on Your Next Steps

If the ball of your foot is causing you pain, our Idaho podiatry team can diagnose the cause and start your treatment immediately. Simply request an appointment online or speak with our staff in Twin Falls or Burley by calling (208) 731-6321.