Sesamoid Fracture: Cause, Diagnosis and Treatment
Before knowing about sesamoid fracture it is necessary to understand what are sesamoid bones.
Sesamoid bones are small oval to round bones a few millimeters in size. They are located with in the substance of tendons close to the joint surface.
Their function is to
- increase the efficiency of muscles by increasing their leverage
- distribute the weight of the body
- protect the tendons from excessive pressure against bones
Before reading on it would be good to first understand the anatomy of the foot (skip this if you already done so).
Here we shall know about the fracture of the sesamoid bones located below the metatarso-phalangeal joint of the great toe within the substance of the flexor hallucis brevis tendon.
Two sesamoid bones are located within the substance of this tendon namely
- tibial sesamoid (located towards the inner side of the foot)
- fibular sesamoid (located towards the outer side of the foot)
The tibial sesamoid can be bipartite. This means that it consists of two bony parts joint by fibrous tissue. It is present in about 10% people.
The tibial sesamoid is more commonly injured because it is located directly below the first metatarsal bone in a central position.
Mechanism of injury is
- fall from height (direct axial load on the sesamoid)
- sports injuries (excessive extension of the great toe joint also known as turf toe)
- chronic stress injury (more common in a bipartite sesamoid)
Symptoms of sesamoid fracture include
- history of injury
- pain around the metatarso-phalangeal joint
- point tenderness over the sesamoid bone
- usually no swelling is present
X rays of the foot are done to confirm the diagnosis. Special views are required to see the sesamoid bones. A bone scan may be required if the diagnosis can not be confirmed by x rays. It is useful to differentiate a fracture of the sesamoid from a bipartite sesamoid.
CT and MRI scans may be required.
Treatment of sesamoid fracture can be operative non-operative.
Non-operative treatment includes
- use of anti-inflammatory medication such aspirin, ibuprofen and diclofenac
- a non weight bearing plaster cast for 6 weeks; you have to use crutches to walk
- use of a metatarsal pad in the shoe to relieve pressure the sesamoid
- a foot splint along with the metatarsal pad
If there is no improvement after a reasonable trial (4 to 6 weeks) of non-operative treatment then surgery is done.
In surgery the involved sesamoid bone is removed (partly or totally).
The above symptoms are also present in a condition called sesamoiditis. It includes the following conditions.
- and arthritis of the sesamoid bones
Treatment of these conditions is the same as mentioned above.
Frequently Asked Questions
How long does it take for complete recovery after operation?
It can take between 4 to 6 weeks for complete recovery after operation.
What are the complications of sesamoid excision?
The following complications can occur
- injury to nerves
- weakening of the flexor muscles of the great toe
- hammer toe deformity may develop
- surgical scar on the sole may become thick and painful
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 23th June 2009.
Other causes of foot pain...
Tarsal Tunnel Syndrome
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