The majority of the bones in our body are attached to each other at the joints. However, there are some bones which are not connected to any bone, but are connected to only tendons or are embedded in the muscle. Such types of bones are known as sesamoids. Patella or kneecap is a good example of a sesamoid bone. Patella is not only a sesamoid bone, but is one of the largest sesamoid. There are additional two more sesamoids, which are the size of a corn kernel. These sesamoid bones are located under the forefoot adjacent to the big toe. There can be inflammation of the tendons which are connected to the sesamoid (sesamoiditis) or there can be breakage of the sesamoid bone (sesamoid fracture).
Treatment for Sesamoid injuries comprises of rest, medications, braces, taping and surgery if needed.
Injury to the Sesamoids
Sesamoids behave like pulleys by providing a smooth surface for the tendons to slide. This increases the capacity of the tendons to transmit force of the muscle. The sesamoids which are located in the forefoot also help with weight bearing and also help in lifting the bones of the big toe. Just like any other bones, fracture can also occur in the sesamoids and they can break. Other than this, the tendons around the sesamoids can also become inflamed or irritated. This condition is known as sesamoiditis and is a type of tendinitis. Sesamoiditis is seen commonly in runners, ballet dancers and professional athletes.
Signs & Symptoms of Sesamoid Injuries
- If one encounters Sesamoid Injury, Pain is felt beneath the big toe, focused on the ball of the foot.
- Pain upon any activity, such as walking, running, jumping etc can also be a symptom of Sesamoid Injury.
- In case of sesamoiditis, there is gradual development of pain.
- In case of fracture, patient experiences pain immediately.
- There may also be bruising and swelling with Sesamoid Injury.
- Patient has difficulty and experiences pain upon bending and straightening the big toe.
Investigations for Sesamoid Injuries
- Physical examination is carried out where the doctor will examine the affected sesamoid bone for pain and tenderness.
- The doctor may also slightly manipulate the sesamoid bone by asking the patient to bend and straighten the affected bone. If the big toe is affected then the doctor will also bend the big toe up towards the anterior side of the foot to see if there is any increase in the pain.
- X-rays of the forefoot are also taken to arrive at the correct diagnosis for Sesamoid Injury.
- A bone scan can also be done if the x-ray looks normal.
- Additionally, blood tests are done to look for other medical conditions, such as inflammatory arthritis or gout
Treatment for Sesamoid Injuries
Treatment for Sesamoiditis
Surgical treatment is not usually required for sesamoiditis and conservative treatment is carried out. If conservative measures do not work, then surgery may be recommended for removing the sesamoid bone (sesamoidectomy). Given below are the conservative measures done for treating sesamoiditis:
- Rest is required and any activity which causes pain needs to be stopped.
- NSAIDs, such as ibuprofen or aspirin, are given to relieve pain, inflammation and swelling, if any.
- Ice therapy should be applied to sole of the foot. Ice should never be applied directly to the skin. It should be wrapped in a towel and applied to the affected area for about 15 minutes or so for every 2-3 hours.
- Patient should wear low-heeled and soft-soled shoes and avoid wearing stiff-soled shoes, like clogs.
- A cushioning pad made of felt can be used to alleviate stress.
- The big toe should be taped so that it remains slightly flexed or bent downward (plantar flexion).
- Patient should return to his/her daily activities gradually and continue wearing a cushioning pad under the sesamoids to provide support to them.
- Patient should avoid any activity which puts stress or any weight on the balls of the feet.
- Steroids can be given to reduce inflammation and swelling.
- If symptoms continue, then a removable short brace for leg fracture can be worn for about a month to month-and-a-half.
- A sesamoidectomy is recommended if the injury does not heal with conservative measures.
Treatment for Sesamoid Bone Fracture
If a sesamoid bone has been fractured, then an orthopedic specialist would start with conservative measures before thinking of surgery.
- Patient will need to wear a short brace for a leg fracture or a stiff-soled shoe.
- The joint may be taped to restrict the movement.
- Patient will need to wear a J-shaped pad surrounding the injured sesamoid to relieve pressure so that the fracture can heal speedily.
- Pain relievers or NSAIDs, such as ibuprofen or aspirin, helps with pain, tenderness and swelling associated with sesamoid bone fracture.
- Orthotic devices or cushioning pads can be worn as the sesamoid bone fracture heals.
- It may take a few months for the discomfort of sesamoid bone fracture to alleviate.
- Sometimes, if the conservative measures fail, surgery is done for a fractured sesamoid.
Recovery Time for Sesamoid Injuries
- In case of sesamoiditis, it takes a few weeks for complete healing to occur.
- In case of sesamoid fracture, patient needs complete immobilization for around 6-8 weeks without any weight bearing before complete healing is achieved.
Prevention of Sesamoid Injuries
- Always wear well fitting shoes, which give good support and cushioning to the foot arches. This is particularly important when the patient is exercising or does strenuous walking. This is also helpful if the patient has to stand on hard surfaces for prolonged periods of time.
- Old worn shoes should always be replaced with new athletic shoes, as the old shoes will stop supporting and cushioning the feet.
- Regular stretching exercises for the foot and the leg should be done, especially before any rigorous physical activity.
- Repeated jarring to the feet should be avoided.
- Always follow the safety rules for any sport and wear protective equipment.