II. Background

  1. Sesamoids: Two flat bones at plantar first MTP
  2. Medial sesamoid is more commonly injured than lateral

III. Mechanisms of injury

  1. Trauma due to falls
  2. Great toe hyperextension
  3. Metatarsophalangeal joint (MTP) dislocation
  4. Stress Fracture of sesamoid

IV. Signs

  1. Pain on palpation of plantar first Metatarsal head
  2. First toe extension refers pain to plantar 1st MTP

V. 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

VI. 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)

VII. Complications

VIII. Course

  1. Anticipate persistent symptoms for up to 6 months

IX. References

  1. Delee (2003) Orthopaedic Sports Med, p. 2512-14
  2. Marx (2002) Rosen's Emergency Medicine, p. 731

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