Sesamoid Disorders And Its Treatments
Almost all feet have two sesamoid bones found on the bottom of the big toe joint
. These two sesamoids are oval, seed-shaped bones. Their purpose is to absorb weight-bearing forces to protect the tendon that runs on the underside of the big toe. They elevate the big toe, which is also known as the hallux, thus assisting in increasing the mechanical advantage of the tendon that bends the hallux toward the floor.
Anatomy of the Sesamoid
Each of the two sesamoids found under the big toe joint have specific names. The sesamoid closer to the little toe side of the foot is termed the fibular sesamoid, and the sesamoid found on the big toe side of the foot is called the tibial sesamoid. If one of the oval shaped bones is in two pieces, it is termed bipartite and if the sesamoid is found in many pieces, it is termed a multipartite. Finally, the sesamoids are anchored to each other, also to the hallux and the first metatarsal by various ligaments and tendons.
Symptoms of Sesamoid Disorders
The most common disorder is called sesamoiditis. This is inflammation of the sesamoid bone and is usually caused by repetitive trauma. It is commonly seen in young adults, athletes, dancers and women that wear high heel shoes. Most of the time, the pain from sesamoiditis is worse with shoes when weight bearing. The pain is located directly under the sesamoid where swelling and redness maybe noted.
Diagnosis of Sesamoid Disorders
To diagnose sesamoiditis the doctor will press on the bottom of the foot in the area of both sesamoids. If pain is elicited when one or both of these bones is palpated the doctor will know that the patients pain is coming from an injured sesamoid bone. An important part of diagnosing sesamoiditis is to evaluate the bones with X-ray imaging. Sesamoiditis cannot be seen on x-ray. The x-ray is used for ruling out other conditions in this area such as fracture, bone tumor or arthritis. If on the x-ray image the sesamoid appears fragmented and the pieces have sharp edges with wide separation relative to each other, it may be indicative of a sesamoid fracture.
Non-surgical Treatment of Sesamoid Disorders
Before surgical treatment is considered, non-surgical treatments are always tried. If the pain on the sesamoids is due to the presence of callused skin, the podiatrist may remove the callus with a scalpel. In the case of sesamoiditis, the first line of treatment is to get the pressure off of the bone. This can be accomplished by applying a Dancer's pad to the foot. This is a pad made of felt or silicone; it has a curved cut out to allow the sesamoid to float. In the case of fractures or dislocations immobilization of the sesamoid is essential for healing. Depending of the severity of the sesamoid disorder, the immobilization can be accomplished with the use of a CAM or boot walker to decrease pressure to the sesamoid. Treatment using ice and non-steroidal anti-inflammatory medication may also be recommended. If the padding helps relieve the pain custom orthotics can be made to off-weight the sesamoids. Corticosteroid injections to the joint can also help alleviate pain.
Surgical Treatment of Sesamoid Disorders
If the sesamoid pain is not alleviated by non-surgical care, then surgical treatment is considered. The most common surgical procedure for sesamoid disorders is a sesamoidectomy (removal of a sesamoid).
Recovery after Sesamoidectomy
After a sesamoidectomy, it is recommended that the patient is non-weight bearing with crutches for 2 weeks, followed by 4-6 weeks in a post-op shoe with protected walking. The podiatrist may recommend joint exercises to prevent stiffness in the joint and custom orthotics to decrease pain and maintain function of the foot. Since sesamoids are important in the function of the big toe, sesamoid removal can change the mechanical balance in the foot. Therefore, removing the sesamoid can result in a decrease of hallux strength, limited big toe joint motion, and positional changes of the big toe.
Copyright (c) 2010 Bruce Lashley
by: Bruce Lashley
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