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

Navigation Tree

Please see the Terms and Conditions. Please also see the privacy statement regarding advertising on this page. Although access to this page is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians.

This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.