Pain to either sesamoid region often times related to overuse injury. Repetitive abnormal stress to either bone can lead to a fatigue fracture of the sesamoid bones.

Symptoms

• Pain with swelling to the bottom of the first metatarsalphalangeal joint noted during walking activity

• Pain typically worse with lifting the heel off of the ground during normal walking cycle

Radiology

• Possible identifiable fracture noted to the involved sesamoid bone with non-painful foot used as a comparison to painful side

• If x-rays are negative for fracture than MRI can be useful in confirming diagnosis

Treatment

Different based on clinical presentation and length of time symptoms have been experienced. All fractures need to be offloaded with reduction of pressure and motion at the fractured bone to facilitate healing. The sesamoid bones have a limited vascular supply and have high pressures from weight bearing and a large amount of motion which can create a difficult environment to heal the fracture. There is a high rate of delayed healing and non-healing of these fractures.

Click to read full article >>