Sesamoid Pain: Causes, Diagnosis, and Treatment Strategies Introduction The two sesamoid bones are found within the flexor hallucis brevis.
Sesamoid Pain: Causes, Diagnosis, and Treatment Strategies The two sesamoid bones are found within the flexor hallucis brevis. There is a medial sesamoid bone, also known as the tibial sesamoid, and a lateral sesamoid, known as the fibular sesamoid. These two bones have been found to support 50% of our body weight at rest and up to three times our body weight during jumping.
Injury can occur due to repetitive stress across the plantar aspect of the great toe and is typically seen in dancers, runners, and football players. Injuries to the sesamoid bones are at high risk of delayed and non union due to the variable blood supply to the sesamoid bones and the high forces the bones are subjected to. Sesamoiditis is a broad term that is used to describe sesamoid pain after all other etiologies of sesamoid pain have been ruled out.
The most common injury to the sesamoid bone is a stress fracture, followed by chondromalacia/sesamoiditis. Acute sesamoid fractures can also occur after trauma. Anatomy of the sesamoid bones Diagnosis A patient with a sesamoid stress fracture will typically complain of plantar forefoot pain.
When examining the sesamoid bones, the medial sesamoid bone is typically affected more than the lateral. Pain is usually palpated on the plantar aspect of the first metatarsophalangeal joint and can be exacerbated with dorsiflexion. Typical radiographs in standing AP, lateral, and oblique views are recommended.
Radiographs can also be misleading because a bipartite sesamoid can be found in 30% of patients. It is important to get bilateral xrays, as the bipartite sesamoid is typically bilateral in 80-90% of patients. If radiographs are indeterminate, an MRI can show bone marrow edema and help diagnose a stress fracture.
If you are experiencing symptoms that may be related to sesamoid pain, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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