Sesamoid Fracture Causes, Symptoms & Treatment Options

Overview

The sesamoid complex lies beneath the big toe and consists of two small bones that help the toe move smoothly, support weight on the ball of the foot, and absorb the impact from running and jumping.

Unlike most bones, sesamoids are not affixed to other bones but are embedded within muscle tissue. The larger tibial sesamoid is located in the inside( medial) head of the flexor hallucis brevis muscle, while the smaller fibular sesamoid sits within its outside (lateral) head.

Fractures are more common in the tibial sesamoid but can occur in either bone. Both types can lead to pain, swelling, and limited motion, sometimes requiring surgical treatment if conservative care does not relieve symptoms.

What causes Sesamoid Fracture?

Sesamoid fractures usually result from repetitive stress or trauma to the forefoot. Over time, small “stress” fractures can develop from repeated pressure during activities like running or jumping.

Sometimes, a sudden impact or fall onto a hard surface can cause an acute fracture. To reduce the risk, avoid sudden increases in training intensity; gradual progression allows the feet to adapt safely.

• How the Injury Occurs: A sesamoid fracture happens when excessive pressure is placed on the ball of the foot, either repeatedly over time or from a single substantial impact. The sesamoid bones absorb much of the body’s weight during push-off, making them vulnerable to overuse and sudden stress.
• Common Everyday Causes: Outside athletics, sesamoid fractures can occur from wearing high heels or hard-soled shoes, standing or walking for long periods, or dropping a heavy object on the foot. People with foot deformities, such as high arches or bunions, may also be more prone to this type of injury.

Sesamoid fractures are most common in these activities:

• Aerobic: Repeated jumping and high-impact moves put constant stress on the ball of the foot.
• Ballet: Pointe and relevé positions place intense pressure on the big toe joint.
• Baseball: Quick pivots and sudden bursts of running can overload the forefoot.
• Softball: Repeated sprinting and sliding increase forefoot stress.
• Gymnastics: Landings from vaults or tumbling can cause direct pressure injuries.
• Track and Field: Sprinting, long jumps, and hurdles all subject the toes to heavy impact.

Other running or jumping sports: Any sport involving repetitive push-offs or jumps increases the risk.

Symptoms

A sesamoid fracture typically causes localized pain and swelling beneath the big toe.. The pain often develops gradually with stress fractures or appears suddenly after a direct injury. Common symptoms include:

• Pain and swelling in the big toe: Especially noticeable when walking, running, or bearing weight.
• Pain when pushing off: Discomfort increases during toe-off movements or rising onto the toes.
• Tenderness over the sesamoid area: Pressing on the underside of the big toe joint causes sharp, focused pain.

In more severe cases, bruising or difficulty bending the toe may also occur, making wearing shoes or performing daily activities uncomfortable.

Non-operative treatment

Most sesamoid fractures heal well without the need for surgery. Non-operative treatment focuses on relieving pain, reducing pressure on the affected toe, and allowing the bone to heal properly. Your doctor may recommend the following conservative measures:

• Rest: Avoid activities that place stress on the ball of the foot, especially running or jumping.
• NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Medications like ibuprofen can help reduce pain and swelling.
• Taping: The injured toe may be gently taped or “buddy bound” to a neighboring toe for added stability and support.
• Crutches: Using crutches can help keep weight off the injured foot during early healing.
• Stiff-soled shoe or walking boot: Helps limit the motion of the big toe and protects the fracture site.
• Orthotics: Custom shoe inserts or pads can offload pressure from the sesamoid area and support proper foot alignment during recovery.

With proper rest and protection, most sesamoid fractures heal within a few weeks to months, allowing a gradual return to normal activity.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Sesamoid Fracture

Surgical Treatment

Surgery is only considered when conservative care fails to relieve symptoms or when the sesamoid fracture is displaced, meaning the bone fragments have shifted apart. Surgical procedures may involve:

• Partial or complete resection of the sesamoid: Removing part or all of the fractured bone to reduce pain and restore function.
• Autogenous bone grafting: Using bone from another part of your body to help repair and stabilize the fracture.
• Shaving of the tibial sesamoid: Smoothing rough or damaged areas to prevent further irritation.

Because sesamoid surgery carries a higher risk of complications, such as stiffness, altered toe mechanics, or persistent pain, surgery is  used cautiously and only when conservative treatment fails..