Sesamoid Injuries of the Foot


While most bones in the body are connected to each other, there are several that are embedded within a tendon or a muscle called sesamoids. In your foot, these small, pea-shaped bones are found in the underside of the forefoot, just beneath the big toe joint.

The purpose of the sesamoids is to act like a pulley—providing a smooth surface to allow the tendons to slide and help the big toe move normally. By doing this, it helps provide leverage when the big toe pushes off during walking and running, while also assisting as a weightbearing surface for the first metatarsal bone.

There are three types of sesamoid injuries in the foot, which can involve the bones, tendons and/or surrounding tissue in the joint.

  • Turf toe – An injury of the soft tissue surrounding the big toe joint.
  • Fracture – A direct result from trauma (acute) or a longstanding injury (chronic).
  • Sesamoiditis – An overuse injury involving chronic inflammation of the sesamoid bones and tendons.

Common Symptoms of Sesamoid Injuries:

  • Pain in the ball of the foot under the big toe
  • Pain when trying to bend or straighten the big toe
  • Swelling and bruising
  • Immediate onset of pain indicates a fracture, whereas sesamoiditis develops more gradually

In diagnosing a sesamoid injury, your podiatrist will perform a physical examination of the foot, focusing on the big toe joint to see if you can move it up and down without an increase in pain. In many cases, x-rays will be ordered to rule out a possible fracture.

Treatment for sesamoid injuries is usually non-invasive and includes:

  • Resting and ice.
  • Oral medications to reduce pain and inflammation.
  • Padding in the shoe to cushion the inflamed area.
  • Taping the big toe to limit movement and relieve that area of tension.
  • A steroid injection to reduce pain and inflammation.
  • Orthotic inserts to help balance the pressure placed on the ball of the foot.

If conservative measures fail, however, your podiatrist may recommend surgery to remove the sesamoid bone.

If you or someone you know believes they may have a sesamoid injury, it’s important to see a podiatrist as soon as possible. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing. Feel free to contact our office at (248)348-5300 or request an appointment on our website.

Dealing with Diabetic Foot Ulcers

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A diabetic foot ulcer is the result of skin tissue breaking down from constant pressure and forming an open sore or wound, typically on the bottom of your foot. People with chronic conditions, such as diabetes, are particularly susceptible to foot ulcers. In fact, about 15 percent of all people with diabetes will develop a foot ulcer at some point in their lives.

In most cases, one of the first signs a patient notices with a foot ulcer is drainage from their foot, but it’s also common to notice swelling, irritation, and/or odor from one or both feet. If you start to notice any of these symptoms, it’s important to consult a podiatrist immediately, as not all signs of foot ulcers are obvious; some may initially resemble a callous or blister with fluid underneath, with red or yellow tissue at the base. If an infection has already set in, it’s common for a toe or part of the foot to turn black due to the absence of healthy blood flow.

Common causes of diabetic ulcers:

  • Poor Circulation
  • Diabetes
  • Nerve Damage
  • Irritated or Wounded Feet
  • History of Smoking
  • Peripheral Neuropathy

During an initial evaluation, your podiatrist will assess the wound and your circulation, in order to determine the best course of action. Depending on the severity, there are several treatment options including debridement, which is the removal of dead or infected tissue from the ulcer, dressings, which are the application of special materials, solutions, or ointments to the wound, and off-loading, which is the use of casts or boots to help decrease pressure at the ulcer site.

The best way to prevent an ulcer on the foot from forming, however, is to treat the underlying health problem, have routine visits with your podiatrists, and follow these important steps:

  • Inspect your feet daily. Holding a mirror up to the soles of your feet will make this easier, but if you’re unable to, ask someone to check your feet for you and ask yourself these questions:
    • Is there any new pain or throbbing?
    • Does your feet feel hotter than usual?
    • Are there any new areas of redness, inflammation or swelling?
    • Is there any discharge?
    • Is there a new smell from your foot?
    • Do you have any flu-like symptoms?
  • Keep your feet clean. Wash your feet every day in warm water and dry them well.
  • Keep your feet soft. Put a thin layer of lotion on the tops and bottoms of your feet (not between your toes). Dry skin can easily crack and peel, making it a target for infection.
  • Nail Maintenance. If you’re diabetic, it’s important to have your nails cut properly by a podiatrist every 2-3 months. 
  • Don’t go barefoot. Always wear socks and shoes to avoid the risk of stepping on something and make sure your shoes fit perfectly to avoid blisters.
  • Stop smoking. Smoking decreases blood flow to your feet, which delays wound healing.

“It’s important to seek care as soon as possible for any cut or wound on the foot,” Dr. Marc Borovoy, a podiatric physician at Associated Podiatrists PC, recommends. “Most wounds have the ability to heal with proper treatment, but a small problem can quickly escalate into a major one if left untreated.”

If you or someone you know is diabetic and/or believes they may have an ulcer, it’s important to have frequent visits with your podiatrist. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing. Feel free to contact our office at (248)348-5300 or request an appointment on our website.