Sesamoid Fracture Causes, Symptoms & Treatment Options

The sesamoid complex sits under the great toe. These are two small bones that facilitate the movement of the great  toe, absorb weight placed on the ball of the foot, and come under a lot of force when running and jumping.

Unlike most other bones, sesamoids are not connected to other parts of the skeleton, but rather are embedded into muscle. The larger tibial sesamoid lies within the medial head of the flexor hallucis brevis muscle; the smaller fibular sesamoid lies within the lateral head.

Fractures are more common in the tibial, rather than in the fibular sesamoid, but both kinds of fractures can cause pain and discomfort and may require surgical intervention in serious cases.

Usually repetitive trauma, which can cause tiny ‘chronic’ or ‘stress’ fractures over time, but trauma may also be acute, caused by a single incident such as a fall or impact against a hard surface. For that reason, it is recommended to avoid suddenly increasing the load or intensity of your training, but rather make these increases in gradual increments over time. Sesamoid fractures are very common in:

• Aerobics
• Ballet
• Baseball
• Softball
• Gymnastics
• Track and field
• Other running or jumping sports.

Typical symptoms of a sesamoid fracture can include:

• Pain and swelling in the great toe
• Pain with pushing off
• Tenderness to palpation of the sesamoid

Contact your physician if you are experiencing any of the following symptoms of a sesamoid fracture:

• Difficulty bearing weight
• Pain under the great toe
• Tenderness under the great toe

Depending on the severity of the condition, your doctor may employ the following imaging techniques for diagnostic purposes:

• X-ray
• Bone scan/MRI

The majority of sesamoid fractures do not require surgical intervention. The following non-invasive treatments may be recommended by your doctor:

• Rest
• NSAIA (nonsteroidal antiinflammatory analgesic) drugs for pain, such as Ibuprofen
• Taping – binding the broken toe to a healthy one
• Crutches
• Wearing a stiff-soled shoe to support the toe
• Orthotics (customized heel or shoe inserts to support your injury)

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Sesamoid Fracture

Surgery may be needed if non-operative treatment does not work. This is more often the case when the sesamoid fracture is displaced (the broken fragments have separated from the fracture). Surgical treatment for a sesamoid fracture can include:

• Partial or complete resection of the sesamoid
• Autogenous bone grafting
• Shaving of the tibial sesamoid

Generally speaking operative  intervention on the sesamoids, especially excision of both sesamoids, should be used very sparingly, as there are lots of potential complications.

It usually takes around 3-6 weeks to treat a sesamoid fracture using non-operative methods, but surgery recovery may take 3-6 months. You can return to play when you have regained your full range of motion and strength and stop experiencing pain.