Causes, Investigation and Treatment of Sesamoid Injuries (Foot Injury):

The first metatarsophalangeal joint is characterized by the two sesamoid bones which play a significant part in the function of the great toe. Embedded within the two tendons of the flexor hallucis brevis, they function to:

• Protect the tendon of flexor hallucis longus.
• Absorb most of the weight-bearing on the medial aspect of the forefoot.
• Increase the mechanical advantage of the intrinsic musculature of the hallux.

Causes

• The sesamoid bones may be injured by traumatic fracture, stress fracture, sprain of a bipartite sesamoid and sprain of the sesamoid-metatarsal articulation.
• Sesamoid abnormality involves inflammatory changes and osteonecrosis around the sesamoid.
• The medial sesamoid is usually affected. Inflammation may be caused by landing after a jump, increased forefoot weight-bearing activities (e.g. sprinting and dancing) or after traumatic dorsiflexion of the hallux.
• Pronation may cause lateral displacement or subluxation of the sesamoids within the plantar grooves of the first metatarsal.
• This subluxation of the sesamoids may lead to erosion of the plantar aspect of the first metatarsal, resulting in pain underneath the first metatarsal head, arthritic changes and ultimately decreased dorsiflexion.

Clinical Features

• The patient complains of pain with forefoot weight-bearing and will often walk with weight laterally to compensate.
• Examination reveals marked local tenderness and swelling overlying the medial or lateral sesamoid.
• Movement of the first metatarsophalangeal joint is usually painful and often restricted.
• Resisted plantar flexion of the great toe elicits both pain and weakness.

Investigations

• Plain X-rays including an axial sesamoid view should be performed to assess for a sesamoid fracture.
• Isotopic bone scan or MRI scan is often required to detect early stress fractures and differentiate between a bipartite sesamoid sprain or inflammation and a fracture.

Treatment

• Treatment of sesamoid inflammation is with ice, NSAIDs and electrotherapeutic modalities to reduce inflammation.
• Corticosteroid injection into the joint space between the sesamoid and metatarsal may prove effective if underlying abnormalities have been corrected.
• Orthoses are required if foot mechanics are abnormal.
• Treatment of sesamoid stress fractures, which occur particularly in basketballers, tennis players and dancers, involves up to six weeks of non-weight-bearing in an air cast or short leg cast.
• The surgical removal of a sesamoid bone should be avoided if possible as removal causes significant muscle imbalances and may contribute to a hallux abducto valgus deformity.

Foot injury is one of the most common injury for sportsmen. Particularly, among all the joints and bone fragments of the foot, the first metatarsophalangeal combined with its sesamoid complicated is the most generally impacted. Call today for best Physical Therapy: (301) 885-2500

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