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Sesamoid Bones - Sesamoiditis - Sesamoid Fracture - Bipartite Sesamoids

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What is sesamoiditis?

Sesamoid bones are bones in the human body that do not attach to other bones via joints, they instead are attached to tendons.

In the foot, there are two small sesamoid bones under each of the big toe joints. Sesamoiditis of the foot is inflammation and pain around these sesamoid bones and in the corresponding flexor hallucis brevis tendons which run adjacent to them.

This can be very debilitating and can be extremely hard to manage as the feet take a lot of stress during day to day life.

How can I help myself?

The sesamoid bones can become inflamed due to impact or injury, or due to prolonged microtrauma from carrying too much weight, wearing footwear that are worn out or have thin soles, or running or walking, especially on hard ground.

If you are a runner or walker or take part in sports, aerobics or high intensity interval training that involves a lot of impact or jumping, making sure your footwear is appropriate is very important and you may need to stop these activities to allow healing if you develop an injury or pain.

If you start to get pain under the big toe joint, initially resting and trying ice therapy may help, as well as possibly using anti inflammatory medication if you are able to.

Addressing any of the above things may help the problem to settle down and prevent it recurring or becoming chronic.

When to see a Podiatrist?

If the problem is very painful or is not improving at all, then see a Podiatrist. They will be able to assess the area and advise on footwear and activity modification in more detail.

They may also advise on possible exercises which may help your foot mechanics and reduce loading of the ball of the foot during activities.

A Podiatrist will also be looking at your biomechanics to see if there is anything that could have predisposed you to this problem and they may advise on possible options such as foot orthoses.

If they are concerned about a possible sesamoid fracture (see below) they may advise immobilisation and imaging of the area such as an X-ray or MRI.

In chronic cases of sesamoiditis, Shockwave Therapy and Steroid Injections and Surgery may be considered.

Sesamoiditis
Sesamoiditis
Sesamoiditis

Sesamoid fracture

What is a sesamoid fracture?

In the foot, a sesamoid fracture refers to a fracture of one or both of the two small sesamoid bones which lie under each of the big toe joints. Fractures can occur due to trauma or impact injury, or can occur from prolonged microtrauma such as in running or jumping activities.

How can I help myself?

If you have had a traumatic injury or overdone it on your feet and could have sustained a fracture, or if you have very acute pain, it is worth resting completely until you can get a medical professional to assess you.

The following links may be useful:

POLICE therapy

Footwear

Ice Therapy

Anti-inflammatory and pain relieving medication

If a fracture is diagnosed, you may be asked to wear a walker to help healing.

When to see a Podiatrist?

A Podiatrist will be able to assess you and take a thorough history of the problem. A fracture may be suspected, but an X-ray may be able to confirm or refute this, though several x-ray angles may be required as it is possible to miss a fracture if only one angle is obtained.

Fractures ideally need to be immobilised for 6-8 weeks to allow healing often using something like a removable rocker bottom walker boot. Although foot orthoses appropriately modified to offload the area, in good footwear, may also be adequate, depending on your circumstances or the severity of the injury.

If it does not heal it may lead to a more chronic sesamoiditis.

Bipartite sesamoids

What is a Bipartite Sesamoid?

A Bipartite sesamoid is a deformity of one or both of the sesamoid bones where it is split into two (but it is possible to have more) segments. Some people develop bipartite sesamoids at birth whereas others are thought to form as a result of a fracture at some point.

These are usually painless, but can be linked to sesamoiditis and sesamoid fractures (See above). 

If your pain is more problematic or is not going away, why not see a Podiatrist?

If you book an appointment, it is a good idea to take the footwear that you wear on a day to day basis, or any sports or exercise specific footwear that you have.

How can I help myself?

Whilst it may be impossible to avoid a traumatic injury, it is more possible to avoid microtrauma. If you are a runner or walker or take part in aerobics or high intensity interval training (HIIT) that involves a lot of impact or jumping, making sure your footwear is appropriate is very important.

If you start to get pain under the big toe joint, initially resting and avoiding aggravating activities may help. The following links may also provide useful information:

POLICE therapy

Footwear

Ice Therapy

Anti-inflammatory and pain relieving medication

Addressing footwear, activity levels and weight management if you are overweight may help the problem to settle down and prevent it recurring or becoming chronic.

When to see a Podiatrist?

As discussed above, a Podiatrist will be able to assess you and take a thorough history of the problem and will develop a diagnosis and management plan based on this and possibly involving imaging such as X-rays, an Ultrasound Scan or an MRI.