The Joint Ventures' Blog

What is a Sesamoid injury?

Tuesday, February 02, 2016

I have a Sesamoid Injury, what does that mean? By definition sesamoid bones are bones that are embedded within a tendon, or the connective tissue linking muscles to bones. The largest example of a sesamoid bone in the human body is your patella which is embedded within the quadriceps tendon. In addition to the patella there are also sesamoid bones present in the thumb, wrist, and foot.


Most commonly a sesamoid injury occurs at metatarsophalangeal joint of the lower extremity, or underneath the ball of your foot. Here there are two sesamoid bones, the tibial and fibular sesamoids, which bear weight through the big toe and act as a pulley system for the flexor hallicus brevis muscle to aid in pushing off during running and walking. The most common injuries to the sesamoids of the great toe include:

Turf toe: an acute hyperextension injury of the flexor tendon

Sesamoiditis: an overuse repetitive inflammation of the flexor hallicus brevis

Sesamoid Fracture: often caused by a traumatic event

Differential diagnosis is made through subjective complaint, mechanism of injury, hands on evaluation, and radiographic imagining. Sesamoid injuries generally take a long time to heal as a result of limited blood supply to the area. Conservative treatment for turf toe, sesamoiditis, and sesamoid fractures generally involves immobilization, rest, NSAID medication, and assistive devices such as crutches and walking boots to decrease weight bearing during the healing process. Treatment may also include steroid injections to aid in the reduction of inflammation. Physical therapy is usually initiated after a period of immobilization to restore joint and tissue mobility and to evaluate gait mechanics for any potential need for orthotics. A home exercise program designed to improve bio-mechanics and reduce the risk for exacerbation will also be included in physical therapy intervention.

Occasionally sesamoid fractures will require surgical intervention due to what is called a non-union fracture. A non-union fracture is one that did not heal conservatively as a result of poor blood flow and repetitive stress to the affected area.  After 8-12 weeks of conservative intervention a non-union fracture is treated with a sesamoid excision which is a surgical procedure designed to remove any lose bodies in the tendon which have not healed properly and remain symptomatic. Post-operatively a patient will be required to ambulate in a walking boot for 2-3 weeks with axillary crutches to maintain a partial weight bearing status before beginning physical therapy to improve motion, strength, and functionality. In rare cases, or with high level performance athletes, a bone graft is performed rather than an excision. This is done to heal the sesamoid fracture with a graft taken from your great toe to maintain the leverage available during push off for explosive sport activities however this intervention requires a period of 12 weeks of partial weight bearing to allow for proper healing during which time physical therapy will begin.

If you have any questions about sesamoid injuries, feel free to stop by the Kenmore Square location or email me at David.Watson@JointVenturesPT.com

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