Sesamoid bones are unique as they are the only bones in the body that are connected to other bones by tendons or are embedded in muscles in the body. Bones are usually connected to other bones by joints. They can be found in several joints in the body such as the kneecap and in the ball of the foot where they appear as two pea-shaped small bones beneath the big toe joint.

Sesamoid bones have several functions including:

• Supporting the body’s weight
• Help in lifting the bones of the big toe during activities
• Allowing tendons to exert greater forces on the body

Sesamoid injuries are associated with activities such as ballet, golf, tennis, basketball, football and running, which require increased pressure on the ball of the foot. The injuries may involve tendons, bones and/or surrounding tissue in the joint. Also, individuals with high aches are more prone to develop sesamoid injuries.

Types of Sesamoid Problems in the Foot

Sesamoid problems in the foot include:

• Turf toe: This is a soft-tissue injury which surrounds the big toe joint. It is caused by the extension of the big toe beyond its normal range. This affects the entire big toe joint, limiting the motion of the toe hence causing sharp pain and swelling. Turf toe can result in an injury to the soft tissue that is attached to the sesamoid or even a fracture of the sesamoid itself.
• Fracture: This can be either acute or chronic. An acute sesamoid fracture is caused by a direct impact or blow to the bone (trauma). It results in immediate pain and swelling at the point of break, but it does not affect the entire big toe joint.

A chronic sesamoid fracture is characterized by longstanding pain in the ball of the foot just beneath the big toe joint. The pain tends to be on and off and is usually aggravated by activity and relieved with rest.

• Sesamoiditis: This occurs when the tendons which surround the sesamoid bones become inflamed and irritated due to increased pressure and overuse of the sesamoid bones and tendons. Sesamoiditis is a chronic sesamoid fracture.

Diagnosis of Sesamoid Problems in the Foot

A physician will begin the diagnosis by asking the patient about the symptoms then follow up with a physical examination of the toe. The patient will be asked to straighten and bend the toe and the doctor will then press on the big toe, move it in different directions, access the patient’s walking and even evaluate the pattern of the patient’s shoes.

The doctor will order an x-ray and may also order an MRI to identify the potential damage to the bones.

Treatment of Sesamoid Problems in the Foot

Treatment for sesamoid problems in the foot include:

• Immobilization: The foot can be immobilized by placing it in a cast or removable walking cast.
• Taping, padding or strapping: This involves strapping or taping the toe or padding a shoe so as to cushion the inflamed sesamoid area in order to relieve tension in that area.
• Medication: Non-inflammatory medication can help in relieving the inflammation and pain.
• Steroid injections: Cortisone can sometimes be injected into the joint to reduce the inflammation and pain.
• Physical therapy: This usually follows immobilization and it ranges from ultrasound therapy to exercises which strengthen and condition the sesamoid.
• Orthotic devices: Custom-made orthotic devices which fit into the patient’s shoe may be prescribed for long-term use so as to balance the pressure that is placed on the ball of the foot.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.