• Background
  1. Sesamoids: Two flat bones at plantar first MTP
  2. Medial sesamoid is more commonly injured than lateral
  • Mechanisms of injury
  1. Trauma due to falls
  2. Great toe hyperextension
  3. Metatarsophalangeal joint (MTP) dislocation
  4. Stress Fracture of sesamoid
  • Signs
  1. Pain on palpation of plantar first Metatarsal head
  2. First toe extension refers pain to plantar 1st MTP
  • Radiology
  1. Foot XRAY AP and lateral
    1. Fracture usually found on xray
    2. Sesamoid partition is a common normal variant
      1. May be difficult to distinguish from Fracture
  • Management
  1. Consider arch supports in mild cases
  2. Short Leg Walking Cast for 4 weeks in most cases
  3. Follow-up with Metatarsal supports after Casting
  4. Refractory pain after Casting
    1. Local Corticosteroid Injection
    2. Orthopedic referral for sesamoid resection (uncommon)
  • Complications
  1. First MTP Degenerative Joint Disease
  2. Nonunion Fracture
  • Course
  1. Anticipate persistent symptoms for up to 6 months
  • References
  1. Delee (2003) Orthopaedic Sports Med, p. 2512-14
  2. Marx (2002) Rosen's Emergency Medicine, p. 731