Sesamoids

Sesamoids are bones embedded in a tendon and are recognized as two pea-shaped bones located in the ball of the foot, beneath the big toe joint.  Injuries to the sesamoids can involve the bones, tendons and/or surrounding tissue of the joint.  They are often caused by individuals participating in physical activities that require increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis and ballet.  Individuals with high arches are at risk for developing sesamoids as well as frequent high-heeled shoe wearers.  There are three types of sesamoid injuries that can occur in the foot: turf toe, fracture and sesamoiditis.  Turf toe is an injury to the soft tissue surrounding the big toe joint and usually occurs when the big toe is extended beyond its normal range.  Symptoms include immediate, sharp pain and swelling.  Sometimes a pop is felt at the moment of injury.  Fracture is a sesamoid bone can be acute or chronic.  An acute fracture is caused by trauma, produces immediate pain and swelling, but does not affect the entire big toe joint.  A chronic fracture is a stress fracture that produces longstanding pain in the ball of the foot behind the big toe joint and is aggravated with activity and relieved with rest.  Sesamoiditis is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones.  It's caused by increased pressure to the sesamoids and often produces a dull, longstanding pain beneath the big toe joint.  Treatment of sesamoids vary, but can include: padding, strapping or taping, steroid injections, orthotics, oral medications, physical therapy or immobilization.  In some cases, surgery may be recommended.