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Portland Foot and Ankle

(503) 244-7894

Battle Ground Foot and Ankle

(360) 687-3668

Vancouver Foot and Ankle East

(360) 834-3707

Vancouver Foot and Ankle West

(360) 597-4223

What is a Sesamoid?
SesamoidA sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.

 

Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.

Types of Sesamoid Injuries in the Foot
There are three types of sesamoid injuries in the foot:

  • Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attached to the sesamoid or a fracture of the sesamoid. Sometimes a “pop” is felt at the moment of injury.
  • Fracture. A fracture (break) in a sesamoid bone can be either acute or chronic.
    • Sesamoid2An acute fracture is caused by trauma – a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint.
    • A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.
  • Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.

Diagnosis
In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient’s walking and evaluate the wear pattern on the patient’s shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.

Non-Surgical Treatment
Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:

  • Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
  • Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
  • Physical therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning) and ultrasound therapy.
  • Steroid injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation.
  • Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.

When is Surgery Needed?
When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

Our Locations


Vancouver Foot and Ankle West


Vancouver Foot and Ankle East


Battle Ground Foot and Ankle


Portland Foot and Ankle


Hours of Operation

Vancouver Foot And Ankle West

Monday:

8:00 am-4:00 pm

Tuesday:

Closed

Wednesday:

Closed

Thursday:

8:00 am-4:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Vancouver Foot and Ankle East

Monday:

Closed

Tuesday:

Closed

Wednesday:

8:00 am-4:00 pm

Thursday:

8:00 am-4:00 pm

Friday:

8:00 am-4:00 pm

Saturday:

8:00 am-12:00pm (Alternating Saturday)

Sunday:

Closed

Battle Ground Foot and Ankle

Monday:

8:00 am-3:00 pm

(Alternating Monday)

Tuesday:

Closed

Wednesday:

8:00 am-4:00 pm

Thursday:

Closed

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

Portland Foot and Ankle

Monday:

Closed

Tuesday:

8:00 am-3:00 pm

Wednesday:

Closed

Thursday:

Closed

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

  • "My 3rd and 4th toes on the right foot were so painful to walk for about 5 years or so. Dr Belnap clipped the tendons in the toes and clipped the nails of both feet on follow up appointments, and now I can walk without pain. I wish I had known of this procedure sooner and will surely recommend this office to friends!

    Side note: I know there has been discussion on getting access to all the x-rays from every location. Is that going to be possible in the future? It would be very helpful for surgical planning, as it is always a good idea to have a copy of the x-rays in the operating room for surgical planning purposes. The other solution I could think of is printing off the x-rays on surgical patients and scanning them into their charts as a document, so you can access them from anywhere.

    Thanks for all your help!!"
    Nancy P.
  • "Dr Belnap is very professional. He helped with my foot pain. He corrected my issues and I was pain-free by the first follow up visit!"
    Dennis B.
  • "I came to Dr Hayes from a personal referral. He has done surgery on both of my feet for bunions. It has helped me to live my busy lifestyle. I have highly recommended him to my friends"
    Susan N.