Sesamoid Injuries

What are sesamoids?

Most bones in the human body are connected to each other at joints, but there are a few bones that are

X-ray showing a medial sesamoid fracture in a young woman with high arches.
connected only to tendons or are embedded in muscle. ​These are the sesamoids. The one that most people are familiar with is the kneecap (patella), which is the largest sesamoid. While the other sesamoids are not always present (and sometimes there are extra), they tend to occur in the foot and hand. Two sesamoids, each about the size of a kernel of corn, are typically found near the underside of the big toe.

How can the sesamoids be injured? 

Like other bones, sesamoids can break (fracture) in a traumatic injury. They can also develop stress fractures from overuse. In addition, the tendons surrounding the sesamoids can become irritated or inflamed. This is called sesamoiditis and is a form of tendinitis or tendinosis. It is common among ballet dancers, runners, and professional athletes.

What are the symptoms of a sesamoid injury?

  • Pain from a sesamoid injury is focused under the big toe on the ball of the foot. With sesamoiditis, pain may develop gradually, whereas with a fracture, the pain will be immediate.

  • Swelling and bruising may or may not be present.

  • There may be difficulty and pain when bending and straightening the big toe.  

How is a sesamoid injury diagnosed?

During your examination, your foot and ankle orthopaedic specialist will look for tenderness at the sesamoid bones. Your doctor may manipulate the bone slightly or ask you to bend and straighten the toe. He or she may also bend the big toe up toward the top of the foot to see if the pain intensifies.

Your specialist will request X-rays of the forefoot to ensure a proper diagnosis. In many people, the sesamoid bone nearer the center of the foot (the medial sesamoid) has two parts (bipartite). Because the edges of a bipartite medial sesamoid are generally smooth, and the edges of a fractured sesamoid are generally jagged, an X-ray is useful in making an appropriate diagnosis. Your physician may also request X-rays of the other foot to compare the bone structure. If the X-rays appear normal, the physician may request a bone scan. Blood tests for gout or inflammatory arthritis may also be considered.

What are treatment options for sesamoiditis?

Treatment for sesamoiditis usually is nonoperative. This is usually successful but can take a long time for symptoms to resolve. If conservative measures fail, your physician may recommend surgery to remove the sesamoid bone. First, your specialist will recommend the following:
  • Stop the activity that causes the pain.

  • Take acetaminophen or ibuprofen to relieve the pain.

  • Rest and ice the sole of your foot. Do not apply ice directly to the skin, but use an ice pack or wrap the ice in a towel.

  • Wear soft-soled, low-heeled shoes. Stiff-soled shoes may also be comfortable, but be aware that some clogs elevate the heel and put more pressure under the sesamoids. These shoes should be avoided.

  • Use a felt cushioning pad to relieve stress.

  • Return to activity gradually, and continue to wear a cushioning pad of dense foam rubber under the sesamoids to support them. Avoid activities and exercise machines that put your weight on the balls of the feet, such as the elliptical and stairclimber.

  • Tape the big toe so that it remains bent slightly downward (plantar flexion).

  • On rare occasion, a steroid injection may be appropriate to reduce swelling. However, be aware that the injection shold not be performed through the thickened fat pad on the bottom of the foot as this can cause loss of hte body's normal fatty cushion in this area.

  • If symptoms persist, you may need to wear a removable short leg fracture brace or cast for four to six weeks. Recognize that the sesamoids tend to heal slowly.

What are treatment options for a sesamoid fracture?

If you have fractured a sesamoid bone, your orthopaedic specialist may recommend conservative treatments before resorting to surgery.

  • You will need to wear a stiff-soled shoe, a short leg-fracture brace, or occasionally, a cast.

  • Your physician may tape the joint to limit movement of the big toe.

  • You may have to wear a J-shaped pad around the area of the sesamoid to relieve pressure as the fracture heals.

  • Pain relievers such as acetaminophen​ or ibuprofen may be recommended.

  • It may take several months for the discomfort to subside.

  • Cushioning pads or other orthotic devices are often helpful as the fracture heals.

  • Occasionally, surgical fixation of a fractured sesamoid is needed.

What is the recovery time?

Healing of the sesamoid is typically slow and can take up to six months. The process can be frustrating, but symptoms typically resolve.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area. ​​