Sesamoid Fracture & Sesamoiditis (Big Toe)

Introduction

The sesamoids are two small bones near the base of the big toe.  They help to bear weight and act as pulleys to help move your big toe when you walk.  Too much repetitive pressure, force, or tension can cause sesamoiditis, an inflammatory condition.  If the impact is great enough, the bones can break (fracture).  The majority of people with sesamoiditis or sesamoid fracture heal well with non-surgical treatment.
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Anatomy

The sesamoids are two very small bones.  They are located at the joint at the base of the big toe on the bottom of the foot.  The sesamoid bones sit in two small grooves and are stabilized by a triangular shaped ligament.  The sesamoid bones help form a pulley system (sesamoid apparatus) for the muscles that move the toe towards the ground when you walk.  They also work with the big toe to bear the forces associated with walking.
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Causes

Sesamoiditis and sesamoid fractures are most frequently caused by significant repetitive pressure and force on the ball of the foot.  Ballet dancers and catchers in baseball are prone to the condition.  However, it may occur from other sources of constant tension and pressure on the forefoot, such as walking, or a strong immediate force, such as falling or jumping from a height.
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Symptoms

Symptoms of sesamoiditis tend to develop gradually and then intensify over time.  You may experience aching increasing to intense pain located beneath your big toe and in the ball of your foot.  Your pain may increase with movement.  It may be difficult to bend or straighten your big toe and to walk. You may or may not experience redness and swelling in the affected area.

A sesamoid fracture causes immediate pain.  You may develop a large bruise under your toe.  Significant swelling throughout the forefoot may make it difficult to bend your toes or walk. 
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Diagnosis

Your podiatrist can diagnose sesamoiditis or a sesamoid fracture by reviewing your medical history and examining your foot.  You should tell your doctor about your activities or any falls or accidents.  X-rays or a bone scan will be taken to help identify a fracture.
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Treatment

Sesamoiditis and sesamoid fractures are most frequently treated without surgery.  Rest, over-the-counter pain medication, and ice can help reduce pain and swelling.  You should wear low-heeled shoes.  Your podiatrist may recommend a specific type of shoe or padding to help relieve pressure.  Tape or athletic strapping may be used to keep your big toe from moving while it heals. 

Steroid injections are used for severe cases of sesamoiditis.  The medication relieves inflammation.  Some people may need to use crutches and wear a removable short leg fracture brace or a below the knee walking cast for several weeks.  Fractures require immobilization and zero weight bearing for six to eight weeks.
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Surgery

Surgery is rarely used for sesamoid fractures, but in some cases it may be necessary if symptoms fail to respond to non-surgical treatments.  A sesamoidectomy is a surgical procedure to remove the sesamoid bone.  The toe joint may be weaker following sesamoidectomy, making it at risk for bunion formation.
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Recovery

Recovery is individualized and depends on the severity of your condition, whether you have a fracture or sesamoiditis, and the treatment that you receive.  Your podiatrist will let you know what to expect.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.