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.