Causes
Types of Sesamoid Injuries in the Foot There are three types of sesamoid injuries in the foot:
- Turf toe - This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the moment of injury.
- Fracture - A fracture (break) in a sesamoid bone can be either acute or chronic. Image An acute fracture is caused by trauma—a direct blow or impact to the bone.
- An acute sesamoid fracture produces immediate pain and swelling at the site of the break but usually does not affect the entire big toe joint.
- A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.
- Sesamoiditis - This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure on the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.
Diagnosis
In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.