Below the big toe there are two unique, small bones that are not connected to another bone, the sesamoid bones. These bones sit within the flexor halluces longus tendon working to facilitate the tendons glide across the big toe and to help redistribute pressure across the large 1st bone of the metatarsals. There are very few sesamoid bones in the body, the kneecap (patella) is the largest sesamoid bone in the body.
These 2 small sesamoid bones are subjected to immense levels of stress with every step taken. There are 3 main types of injury that can occur specifically to the sesamoid bones in the ball of the foot:
Pain will be focused directly under the 1st metatarsal and big toe, if left long enough the pain will radiate into the foot with an obvious difficulty with bending and straightening the big toe. Swelling and bruising in this location should be addressed immediately.
Injuries to these bones may occur suddenly or over a long period. Patients may not even know there is an injury until they feel pain or take an x-ray. Factors that increase the likelihood of developing sesamoid problems include:
Wearing slippers that offer no support and increase chance of injury to the foot.
Most patients do not know they have these small bones at the front of the foot let alone an injury to them. Injury to these bones results in chronic (long standing) pain in the ball of the foot. Leaving such an injury can result in surgical intervention of the affected bone, early intervention is key to success in treating such injuries.
Sesamoid problems must have a clear diagnosis from your practitioner. Treatments may include:
Pain in the sesamoids must be differentiated from other similar problems, patients must rule out:
Author: Podiatrist Georgina CALLAGHAN-TAY