Sesamoid fractures are rare but definitely do happen and, when they do, it they can be extremely painful. The sesamoid bones are in the hand, wrist, and just below the big toe. Breaking the sesamoid bones below the big toe can be debilitating and may require surgical intervention. As these small bones are a pulley with the tendons, breaks can lead to problems moving the big toe when walking, not to mention the associated aches. Although the first line of treatment for these breaks is a conservative watch-and-see approach, a medical professional may decide that further treatment options are necessary if healing does not progress or if the pain is too much.
Understanding Foot Anatomy
The two sesamoid bones at the base of the big toe have several functions vital to the foot. Breaks to these bones sometimes require a visit to a foot and ankle orthopedic surgeon. Sesamoid bones help to:
- Distribute weight across the ball of the foot when you walk and run.
- Absorb impact, protecting the tendons, including the flexor hallucis brevis (one of four muscles in the foot), from excessive pressure.
- Give the tendons greater leverage to push-off during specific foot movements.
Fractures to these small pea-sized bones can affect the functions above, making walking painful and running impossible. You can fracture one or both of these bones and not know it because this type of injury often goes undiagnosed.
Understanding the Primary Causes of Sesamoid Fractures
Sesamoid fractures can occur because of acute trauma or chronic overuse. Understanding the reasons for these breaks can help you know what to expect from recovery.
Acute Trauma
this is one of the most common causes of sesamoid fractures and injuries. Sudden impacts from landing on the foot wrong or a hard blow to the foot can lead to fractures in these bones. Thus, it makes sense that those who regularly do basketball, football, and dance are more likely to suffer sesamoid bone fractures (although it can happen to anyone).
Chronic Overuse
Stress fractures in the sesamoid bones can also happen because of chronic stress. Athletes who do repetitive high-pressure activities like jumping and running can experience stress fractures in the sesamoid bones. The repetitive pressure on the bones can lead to tiny cracks called microfractures, which can eventually become complete fractures.
You may experience increased risks of sesamoid bone fractures if you have naturally high arches. Some people also have larger than normal sesamoid bones that can predispose them to fractures.
What are Signs of Sesamoid Bone Fractures?
One of the common symptoms of sesamoid bone fractures is pain in the ball of the foot. The pain can range from a dull ache to a sharp pain when standing or walking. Bending the toe can often lead to excruciating pain at the base.
Other symptoms you may experience with a break to these bones are:
- Noticeable swelling around the base of the big toe
- Tenderness when you press at the base of the big toe
- Problems with bearing weight on the affected foot
- Reduced movement in the big toe joint
- Bruising at the base of the toe
In the case of stress fractures, the symptoms may start as mild and worsen as the fractures increase in size. The severity of the pain will depend on the extent of the injury. Acute trauma often results in sudden and intense pain that doesn’t go away.
How do Doctors Diagnose Sesamoid Bone Fractures?
Doctors can diagnose sesamoid bone fractures after thorough examinations and testing reveal broken bones. But reaching a proper diagnosis is not always easy.
Medical History
The doctor will take a detailed patient history to determine the patient’s lifestyle. It is important to describe your activities and any recent foot injuries to the doctor. They will then do a complete foot examination to determine structural deformities that could lead to pain or increased injury risk. This medical expert will check for tenderness, swelling, bruising, and issues with range of motion.
They will also perform imaging tests, which will likely include x-rays. X-rays are typically used to diagnose broken bones, but the small structure of the sesamoid bones can make finding issues with them difficult. Bone scans and MRIs may be ordered to detect more minor fractures and soft tissue injuries that sometimes happen alongside sesamoid bone fractures.
Understanding Treatments for Sesamoid Bone Fractures
The doctor will create a treatment plan for you and oversee it, with the approach(es) depending on the severity and type of fracture, and other factors. Some patients require several treatments, depending on how they respond to the first strategies.
Rest
Most people will see an improvement with rest alone, especially if they have a minor fracture. To give the foot time to heal, the dr. might recommend you stay off it and walk on crutches. They might also suggest elevating the foot regularly. Depending on the injury, your doctor may have you get a walking cast or boot to give the foot a complete rest.
Orthotics
Orthotics can help alleviate minor pain associated with sesamoid stress fractures. They offload the pressure from the bones, allowing them to heal. Orthotics can also help prevent sesamoid injuries.
Pain Management
NSAIDs are typically the first line of treatment for pain; only take what the doctor recommends and according to the suggested dose. That may help with managing the pain and reducing inflammation. To combat swelling and inflammation, ice is another thing your doctor may tell you to do.
When Do Sesamoid Fractures Require Surgury?
Most sesamoid fractures heal without surgery. But, sometimes, surgical intervention is needed. Here are some examples when a doctor might decide surgery is the best option:
- The fracture has not healed within a year
- Ongoing pain, despite conservative treatments
- Severely displaced the sesamoid bones
- Sesamoid osteonecrosis (A rare condition)
Types of Sesamoid Surgery
- Sesamoidectomy (The removal of one or both bones)
- Internal fixation (Realignment of the bones)
- Bone grafting (Using bone taken from elsewhere in the body)
See a Medical Professional
Sesamoid fractures can be difficult to treat and cause chronic issues for some people. Although surgical intervention, such as sesamoidectomy, may become necessary, further issues can result due to the altered biomechanics of the foot.
Note: This post if for information purposes only; it does not take the place of medical advice. If you experience an injury or notice the symptoms above, it is essential to seek a diagnosis. If you need surgery, see a doctor to learn about your options and determine the best procedure to alleviate pain and regain mobility.
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