Sesamoid Fracture 

Sesamoid Fracture is rare, and often misdiagnosed as soft tissue damage (Turf Toe, Sesamoiditis).  Sesamoids are bones that are not connected to any other bone, but are instead embedded in muscle, or connected only to tendons.  The patella (kneecap) is the largest sesamoid bone.  Two other sesamoids are found in the ball of the foot, under the first metatarsophalangeal (MTP) joint.  This is where your big toe joins your foot.  The pea-sized medial tibial sesamoids are embedded in the tendons of the plantar fascia and help move your big toe.

Causes

Pain may develop gradually if the sesamoid injury is a stress fracture from overuse (chronic), or it may be due to a sudden, traumatic injury (acute).  Runners, ballet dancers, and other professional athletes who bear weight on the ball of the foot may be more susceptible to both chronic and acute sesamoid fractures. 

Symptoms

• Pain in the big toe and ball of the foot
• Redness
• Bruising
• Swelling
• Tenderness
• Limited range of motion

Non-Surgical Treatments

• Rest – it can take 6-12 weeks to fully heal a sesamoid fracture
• Elevation – keeping your foot above your heart level can help reduce pain and swelling
• Immobilization – splinting may be used to keep the toe in a fixed position
• Ice – applied over a towel, ice packs help reduce pain and swelling
• Non-steroidal anti-inflammatory drugs (NSAIDs) – to manage pain and swelling
• Prescription pain relief – to manage pain and swelling
• Cortisone injection – reduces swelling in the immediate area
• Crutches – so that no weight is placed on the injured joint
• Physical therapy – strengthens the big toe and improves range of motion

Surgical Treatments

If your injury does not respond to non-surgical treatment, your doctor may recommend a screw-fixation technique to stabilize the fractured sesamoid bone.  In severe cases, as sesamoidectomy (removal of the bone) may be performed.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437128/

https://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments

https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/turf-toe.html

https://orthoinfo.aaos.org/en/diseases–conditions/turf-toe

https://www.orthonorcal.com/sesamoid-fracture-orthopedic-specialists-los-gatos-morgan-hill.html