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Sesamoid Dysfunction and Fracture, Sports Medicine

Laura M. Distel, MD, CAQSM and James R. Borchers, MD, MPH Reviewed 04/2019
 


BASICS

  • Anatomy:

    • Two sesamoid bones: the larger tibial (medial) sesamoid and fibular (lateral) sesamoid

    • Located on the plantar side of the 1st metatarsophalangeal (MTP) joint, just proximal to the metata...

DIAGNOSIS

HISTORY

  • Gradual onset of pain on the plantar surface of the 1st hallux

  • Pain with dorsiflexion or weight-bearing 1

  • Unilateral symptoms are typical.

  • Pain typically is located at the medial sesamoi...

TREATMENT

  • Sesamoiditis or stress fracture/nonunion:

    • Initially, conservative therapy is recommended for at least 4 to 6 wk 1,5,6[A]:

      • Relative rest with immobilization by offloading the 1st MTP complex wi...

ONGOING CARE

  • Custom orthotics ± cutouts for the sesamoid bones 3

  • Short-leg walking cast can be considered for recalcitrant cases 1.

  • Corticosteroid injection into the sesamoid area can be considered with...

REFERENCES

1
Dedmond BT, Cory JW, McBryde AJr. The hallucal sesamoid complex. J Am Acad Orthop Surg.  2006;14(13):745–753.
2
Mittlmeier T, Haar P. Sesamoid and toe fractures. Injury.  2004;35(S...

CLINICAL PEARLS

  • Medial sesamoid is injured most commonly.

  • Acute fractures are almost exclusively unilateral.

  • Bilateral bipartite sesamoids are usually benign.

  • Tenderness over the sesamoids or pain with d...

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