Sesamoid Fracture & Sesamoiditis 

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 without surgery.

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Anatomy
The sesamoids are  two small bones.  They are located at the joint at the base of the big toe on the bottom  of the foot.  The sesamoid bones are located in two small grooves and are stabilized by a triangular shaped ligament.  They 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 your weight, and 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 gradual aching 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 walk.  You may or may not experience redness and swelling in the affected area.
 
A sesamoid fracture causes immediate pain.  You will probably have a large bruise at your toe joint.  Significant swelling throughout the forefoot may make it difficult to bend your toes and forefoot or walk.  

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Diagnosis
Your doctor 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 may be taken to help identify a fracture.

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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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Treatment
Sesamoiditis and sesamoid fractures are most frequently treated without surgery.  Rest, over-the-counter pain medication, and  ice packs can help reduce pain and swelling.  You should wear low-heeled shoes.  Your doctor 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 fracture brace or a  walking cast for several weeks.  Fractures require immobilization and zero weight bearing for up to six to eight weeks. Physical therapy exercises after immobilitation can help increase strength, motion, and function.

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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 doctor 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 April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.