By Dustin L. Kruse, DPM
The ball of your foot may look smooth and round from the outside, but inside you will find some complex mechanisms. The foot and toe bones join there, tied together by ligaments, moved by tendons and muscles, stimulated by nerves, and supplied with nutrients by tiny blood vessels. Under your big toe joint, there are two extra bones called sesamoids that may look insignificant but risk being damaged because they play a big role in your movement. Sesamoid injuries can cause lots of trouble and pain.
What Do Sesamoids Do?
For one thing, these small round bones help bear your body weight. A study of how your foot moves as you walk shows that just before you push off to move your foot forward, most of your weight bears down on the ball of your foot—specifically your big toe. These two bones help bear that weight and take some of the pressure off the metatarsal heads.
Because they are embedded in the tendons and not fastened to other bones, the sesamoids act rather like ball bearings or pulleys, so the tendons can move smoothly instead of scraping along each other. They also provide leverage for the big toe, helping put that spring in your step when running and jumping.
What Types of Sesamoid Injuries Occur?
Because of all the weight and pressure on the ball of your foot when you are active, the ligaments, tendons, other tissues, and the little bones themselves can all be injured. Here are the mishaps that occur most often:
- Sesamoiditis – If you have dull pain under the big toe joint that never seems to go away, the bones or related tendons may have become inflamed. This happens from overuse and trauma over time, and may be aggravated by certain activities or footwear.
- Turf Toe – This involves a sprain of one or more of the ligaments of the big toe joint. It happens when your toe is bent too far back toward your shin and the ligaments become stretched or torn. It is often a sports-related injury, although it can happen in other ways, too. You will immediately feel sharp pain, followed by swelling, stiffness, and inability to move your toe.
- Fracture – You could have a small crack (stress fracture) in a sesamoid caused by overuse, or a small chip could be pulled away or the bone entirely cracked from an accident or landing hard on something. A chronic stress fracture will likely have pain that is worse when you are using your foot and better when you are resting. A sesamoid fracture will hurt and swell at the site of the break, but you may still be able to move your toe joint.
What Is the Treatment for Sesamoid Injuries?
Remedies vary according to your specific condition. For sesamoiditis, we may recommend limiting your activities to those that don’t cause pain, icing the area to reduce swelling and pain, wearing well-cushioned shoes, using padding or inserts, or taping the toe downward to reduce the stress on the tendons.
For sesamoid fractures a short leg brace, stiff-soled shoe, or taping may be used to keep the big toe joint immobile. We may advise you on the best pain reliever for your situation, or design cushioning pads or orthotics to relieve your discomfort. Remember that it may take several weeks or even months for the bones to heal completely.
Will I Need Surgery?
It is unlikely, as most sesamoid injuries respond to conservative treatment. If they do not, we can help you decide whether surgery may be worthwhile. We are known for our surgical expertise, so if this is the path you must take, rest easy that your feet are in great hands.
When you are ready to deal with the pain and stiffness of your big toe joint, contact Rocky Mountain Foot & Ankle Center by calling (303) 423-2520 and setting up an appointment at our or Wheat Ridge or Golden, CO, office. We also have satellite offices in Granby and Evergreen, if those are more convenient for you, and you can schedule right on our website. While you are at it, ask for our free User Guide to Foot and Ankle Health to get more information about keeping your feet safe and ready to go.
Photo Credit: GLady via Pixabay.com