SESAMOID INJURIES

SESAMOID INJURIES

The two major sesamoid bones in the foot lie under the first metatarsal head. A sesamoid bone is a specialized bone within a tendon that works to increase the fulcrum and thereby increase the force of a powerful muscle. The largest example is the patella or kneecap, which helps to strengthen quardriceps function by 50%. Similarly, the most powerful motion in the foot is push-off during gait, and the two sesamoids help to increase the force. Given their location on the bottom of the foot, however, they are susceptible to injury.

Similarly, the most powerful motion in the foot is push-off during gait, and the two sesamoids help to increase the force. Given their location on the bottom of the foot, however, they are susceptible to injury.

seasamoid

Causes

Common causes of injury of sesamoids are significant forces to the bottom of the foot, such as a fall from height. Repetitive impact such as sprinting or dance (especially in the demi-pointe relevé position) can also cause a fracture or injury. Certain foot shapes such as those with high arches predispose to injury, as does high-heeled shoewear.

Some people are born with sesamoid bones that are in two segments, which can appear to be a chronic fracture. The tenuous connection between the two parts can be injured.

seasamoid

DIAGNOSIS

A set of high-quality weight-bearing (standing) x-rays are required for diagnosis, as well as a thorough physical examination. Sometimes, an MRI and CT scan may be necessary.

TREATMENT

Shoewear modification to avoid high heels and thin-soled shoes that predispose to injury.

Orthotics to normalize the foot’s contact with the ground and offload areas of pressure. The standard orthotic for this purpose stiffens the shoe and provides a softer area directly under the sesamoid.

Occasionally surgery is necessary when the pain is not able to be treated. This requires removal of the injured sesamoid and reconstruction of the tendon that it is removed from. Because of the delicacy of the reconstruction, the rehabilitation from this surgery is prolonged nonweightbearing and the use of an orthotic for six months after surgery.

seasamoid

FOR BEST RESULTS

Shoewear modification to avoid high heels and thin-soled shoes that predispose to injury.

Orthotics to normalize the foot’s contact with the ground and offload areas of pressure. The standard orthotic for this purpose stiffens the shoe and provides a softer area directly under the sesamoid.

Occasionally surgery is necessary when the pain is not able to be treated. This requires removal of the injured sesamoid and reconstruction of the tendon that it is removed from. Because of the delicacy of the reconstruction, the rehabilitation from this surgery is prolonged nonweightbearing and the use of an orthotic for six months after surgery.

WHAT THEY SAY ABOUT US

★ ★ ★ ★ ★

I came to Dr. Dixon with a painful bunion, not really knowing what I could feasibly do about it. She asked me a lot of questions to understand not just what was happening with my foot, but what my concerns were. She took a lot of time to explain my options to me, both surgical and non-surgical, and made sure that I understood so that I could make the best decision for myself. She was amazing – I didn’t feel rushed, and felt really comfortable asking questions! I would trust her with any problems I had with my feet.

Katie Y.

★ ★ ★ ★ ★

What to say about Dr. Dixon other than she is a one woman wonder. My best friend took a12′ fall while helping a friend move a piece of furniture downstairs. He had a pilon fracture of his right leg and, because he is on SSI, I dispaired for his care. Was he going to be crippled for life? Would he get a surgeon that would be able to deal with the complexities of this accident? Would anyone care about him enough to ensure his rehab? Yes. He was! So fortunate to have had the great fortune to have Dr. Alexis Dixon as his surgeon and friend. She can be starchy, true, but that is because she cares to make sure that rehab, therapy, and directions are taken seriously. My friend is recovering from this accident and is now taking an SDI class. He has a way to go yet but its looking good. So grateful for Dr. Dixon.

Noël J.