Welcome to Momentum Health's patient resource in Calgary about Sesamoid Problems.
Two pea-sized bones, called sesamoids, are embedded within the soft tissues under the main joint of the big toe. Even though they are small in size, the sesamoids play an important role in how the foot and big toe work. If the sesamoids are injured, they can be a source of severe pain and disability.
This article will help you understand:
how the sesamoid bones in the foot work
how sesamoiditis develops
what can be done for the condition
Hear from some of our Foot Therapy patients
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Sprained my ankle while playing soccer. Got the best treatment from the best physios Mark Taylor and Sofia. They were patient enough to answer all my dumb questions. Also want to mention about the... ”
“ Sprained my ankle while playing soccer. Got the best treatment from the best physios Mark Taylor and Sofia. They were patient enough to answer all my dumb questions. Also want to mention about the lady at the front desk who was really kind. Overall, received the treatment that I was looking for and people are amazing! Highly recommend, would give 6/5 stars. ”
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My wife and I are very selective customers of about everything. If we spend money in today's world, we should get a top and customer-oriented service. The same goes for accessing physiotherapy and... ”
“ My wife and I are very selective customers of about everything. If we spend money in today's world, we should get a top and customer-oriented service. The same goes for accessing physiotherapy and other rehabilitation services after a trauma or a motor vehicle accident. I had never experienced good at other physiotherapists' clinics before. Most clinics are more interested in your insurance money than their patients' complete recovery. I can be biased, but it is my personal opinion. I was very apprehensive in my search for a professional physiotherapy center. I Google-searched for nearly two days and read lots of reviews. I narrowed my search and selected Momentum Health at Deerfoot and 64th Avenue, NE. I can say my hrs. long search was not in vain. The treatment is top-notch and very professional in medical and customer services. I highly recommend this clinic for any massage, physiotherapy, or related service. My physiotherapist, Mark Taylor, Kinesiologist, Safia, and massagist, Meagan, are professional and sincere healthcare professionals. They go beyond and above to help you with your problem. They listen to you and then advise accordingly. I highly recommend this clinic and those individuals I dealt with. It is worth your money, time, and energy to give them a chance and try their positive, effective, and professional service. I will go back to them for sure again if another occasion arises. ”
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I recently saw Joel for an ankle injury. He was professional, empathetic and really helped me understand my limits. I really felt comfortable with his IMS techniques and I felt a lot of relief... ”
“ I recently saw Joel for an ankle injury. He was professional, empathetic and really helped me understand my limits. I really felt comfortable with his IMS techniques and I felt a lot of relief following! One could say he has ‘magic hands’. 5/5 service! ”
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Just had an amazing deep tissue massage from Christina. Walked in with major foot pain. Told her exactly where it hurt. She messaged the area and listened to me if it hurt too much. She then worked on... ”
“ Just had an amazing deep tissue massage from Christina. Walked in with major foot pain. Told her exactly where it hurt. She messaged the area and listened to me if it hurt too much. She then worked on areas she thought would help my foot and it worked. I got up from the table and could walk without pain. The deep tissue massage was perfect. She kept asking if the pressure was good or too much and acted accordingly to my answer. There’s a reason she books so far out. She’s that good. Extremely happy to have found Christina. I would highly recommend her to anyone ”
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Rebecca and Karissa have helped me immensely in recovery from a ruptured achilles tendon. Their guidance and program has helped me heal and strengthen the injury. Top notch quality and care from the... ”
“ Rebecca and Karissa have helped me immensely in recovery from a ruptured achilles tendon. Their guidance and program has helped me heal and strengthen the injury. Top notch quality and care from the best people. Thanks for everything! ”
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I have been a client of Brad Fugimoto for several years and when I developed a sore heel (plantar fasciitis ), I asked him about it. He found that my calf muscle was very tight and said if I could... ”
“ I have been a client of Brad Fugimoto for several years and when I developed a sore heel (plantar fasciitis ), I asked him about it. He found that my calf muscle was very tight and said if I could tolerate deep massage of it, the heel pain would likely resolve. However I didn't think I could tolerate it so decided to try other practitioners, including seeing a podiatrist for new orthotics, another chiropractor for Cold Laser, a Physiotherapist for Ultrasound and Acupuncture , plus doing many prescribed exercises. The pain persisted. So I saw my Homeopath/RN for her opinion. She diagnosed it as a muscle/fascia problem of the lower leg which caused the inflammation in the plantar fascia (heel). Bingo! She recommended a technique called Myofascial Release. This is the same as what Brad had described 3 months ago. So back to Brad I went and after one treatment (which was painful), the heel pain is relieved about 50% and hopefully a few more treatments will bring it back to normal. I very much recommend Brad Fugimoto for his expertise, professionalism and his intuitive ability. ”
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Mark, our physiotherapist was absolutely amazing!! My son sprained his ankle playing sports and months later it was still bothering him to the point he couldn’t play for his competitive soccer team... ”
“ Mark, our physiotherapist was absolutely amazing!! My son sprained his ankle playing sports and months later it was still bothering him to the point he couldn’t play for his competitive soccer team anymore. Mark spent time with him on a weekly basis for a few weeks and drew up a plan for him to also work on his ankle at home and now he is 100% pain free!! Mark made my shy son feel comfortable during his visits and helped him so much! Even on our last visit, my son had strained his neck sleeping awkwardly one night and one visit with Mark fixed him right up! I highly recommend Momentum Health Deerfoot! Thanks so much to Mark and the very friendly reception staff who always made our visits enjoyable! ”
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Good morning i have been having nerve problems and numbness in my left leg hip and ankle, since i have been coming there i have been treated with respect and kindness for my problem, i feel very... ”
“ Good morning i have been having nerve problems and numbness in my left leg hip and ankle, since i have been coming there i have been treated with respect and kindness for my problem, i feel very confident that the team there will help me to get better if possible. Russ is awesum he has done things that no other physio place has tried i believe he accutually cares about my injury and healing process. Hats off to all of you i would recommend treatment here for anyone who has issues with your body. ”
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I have been working with Mark Taylor to help remidy my ankle tendonitis for a couple months now, already seeing massive improvements and very little pain anymore. Would recommend. ”
“ I have been working with Mark Taylor to help remidy my ankle tendonitis for a couple months now, already seeing massive improvements and very little pain anymore. Would recommend. ”
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I've been coming here for a few months. My foot got crushed in forklift incident at the company I was working for and I've been having to learn how to walk on the for again. So far my experience has... ”
“ I've been coming here for a few months. My foot got crushed in forklift incident at the company I was working for and I've been having to learn how to walk on the for again. So far my experience has been positive with Mark being easy to talk to and not overbearing or aggressive. The current negative is that finding the location is hard due to the set up of the mall, but that is the fault of the overseers Shape Properties not knowing how to do competent address designation. ”
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I had an inflamed Achilles’ tendon after rolling my ankle during a winter run. I could barely walk. Amy diagnosed the problem and gave me treatment and exercises that set me right. She focused on... ”
“ I had an inflamed Achilles’ tendon after rolling my ankle during a winter run. I could barely walk. Amy diagnosed the problem and gave me treatment and exercises that set me right. She focused on strengthening my ankle so the problem would not re-occur and stretching to address muscle tightness. The team at Momentum West Springs is my first choice whenever I have an injury. I trust them to get me back fast. Thanks Amy and Nicole! ”
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My first trip to Momentum Health Ogden today had me meeting with Meghan Murphy for physio for my Achilles Tendonitis. She was thorough, knowledgeable and thoughtful of my pain tolerance. I’m... ”
“ My first trip to Momentum Health Ogden today had me meeting with Meghan Murphy for physio for my Achilles Tendonitis. She was thorough, knowledgeable and thoughtful of my pain tolerance. I’m confident in the regimen she’s laid out for my recovery and highly recommend her to help you work through any injuries you may have! ”
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Kaylie and Rachel were absolutely phenomenal in getting me back to life and mobile. I came in with a serious ankle sprain and developed a secondary sprain on my other ankle, too. They worked... ”
“ Kaylie and Rachel were absolutely phenomenal in getting me back to life and mobile. I came in with a serious ankle sprain and developed a secondary sprain on my other ankle, too. They worked diligently with me to make sure I was progressing in my healing process and are both extremely friendly. I would highly recommend Momentum Health and Rachel and Kaylie if you are in need of physiotherapy treatment! ”
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Kaylie and Rachel were an amazing team helping to heal my foot. They were super knowledgeable about the body and friendly to chat with during each session. Thanks so much for the help!!! ”
“ Kaylie and Rachel were an amazing team helping to heal my foot. They were super knowledgeable about the body and friendly to chat with during each session. Thanks so much for the help!!! ”
The main joint of the big toe forms the inside edge of the ball of the foot. The two small sesamoid bones are located on the underside of this joint. There is one sesamoid bone on each side of the base of the big toe.
Sesamoid Bones
One Sesamoid Bone (on each side)
The muscles that bend the big toe down (the toe flexors) pass underneath the main joint of the big toe, crossing over the bump formed by the sesamoid bones. This bump acts as a fulcrum point for the toe flexors, giving these muscles extra leverage and power. The sesamoids also help absorb pressure under the foot during standing and walking, and they ease friction in the soft tissues under the toe joint when the big toe moves.
Sesamoid pain can develop a number of different ways. When the tissues around the sesamoid bones become inflamed, doctors call the condition sesamoiditis. Sesamoiditis is often caused by doing the same types of toe movements over and over again, which happens in activities like running and dancing.
Fractures can also cause pain in the sesamoids. Fractures can occur when a person falls and lands bluntly on the ball of the foot. Stress fractures can also occur in the sesamoid bones. Stress fractures are usually caused by the strain of overworking the soft tissues. Athletes most often suffer stress fractures of the sesamoids because of the heavy and repeated demands that training places on the soft tissues of the foot and big toe.
Arthritis can develop where the sesamoids glide under the bone of the big toe. The sesamoid bones create a joint where they move against the bone of the big toe. Like other joints in the body, this joint can also develop arthritis. Arthritis is more likely to be a problem in people who have high arches in their feet. The high arch causes the main joint of the big toe to become rigid. This focuses strain and pressure on the sesamoids.
In some cases, blood supply to the sesamoid bone is decreased. This condition is called osteochondritis. Osteochondritis causes a piece of the bone to actually die. The body's attempts to heal the area may build up extra calcium around the dead spot.
Sometimes sesamoid pain comes from extra tissue under the big toe joint, similar to a corn. Doctors call this extra tissue an intractable plantar keratosis.
Plantar Keratosis
Symptoms
What does sesamoiditis feel like?
People with sesamoid problems usually feel vague pain under the main joint of the big toe. The sesamoids typically feel tender when touched. Movement of the big toe is often limited. People tend to notice pain mostly when their big toe is stretched upward, which can happen when the back foot pushes off for the next step. Occasionally the joint catches or pops. The catching or popping is often followed by increased pain, which usually eases after resting. Some people report feelings of numbness in the web of the first two toes.
Toe Stretched Upward
Diagnosis
How do health care providers identify this problem?
When you first visit Momentum Health, our physiotherapist will ask many questions about your medical history. We’ll ask you about your current symptoms and whether you've had other foot and joint problems in the past. Our physiotherapist will then examine your painful toe by feeling it and moving it. This may hurt, but it is important that we locate the source of the pain and determine how well the toe is moving. You may also be asked to walk back and forth.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Momentum Health have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Our Treatment
What can be done for the condition?
Many cases of sesamoiditis can heal completely with careful treatment. There are two methods for treating sesamoid problems, nonsurgical treatment and surgery. Surgery is most often used as a last resort, when other forms of treatment aren't helping.
Non-surgical Rehabilitation
Although each patient recovers at a different rate, as a general rule, our patients with sesamoid problems typically undergo four to six physiotherapy treatments. Your physiotherapist can offer ideas of pads or cushions that help take pressure off the sesamoid bones. We may recommend that special padding in the shape of a J can be placed inside your shoe to ease pressure on the sesamoids as you stand and walk. You may need to limit the amount of weight placed on your foot when you're up and about. Shoes with low heels may also ease the pressure. Your doctor may also recommend supplementing rehabilitation with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.
Our physiotherapist may apply treatments to the painful area to help control pain and swelling, such as ultrasound, moist heat, and soft-tissue massage. Our physiotherapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory drugs, prescribed by your doctor, into the sore area.
If simple modifications are made to your shoes you may be allowed to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside. If we must use more aggressive treatment during your recovery, you may be required to use crutches for several weeks to keep weight off the foot.
Post-surgical Rehabilitation
After a surgical procedure to shave or remove bone, patients are generally placed in either a rigid-soled shoe or a cast for two to three weeks. We will help you learn to properly use crutches to limit the weight that you put on your foot during the early stages of your recovery.
Treatment is more cautious after bone graft surgery. Patients usually wear a cast for up to four weeks. Then they wear a short walking cast for another two months, at which time active exercises can start.
The physiotherapists at Momentum Health can develop a personalized physiotherapy program to help speed your rehabilitation. When your recovery is well under way, regular visits to Momentum Health will end. Although we will continue to be a resource, you will eventually be in charge of doing your exercises as part of an ongoing home program.
Momentum Health provides services for physiotherapy in Calgary.
Surgery
If surgery becomes necessary, several procedures are available to treat sesamoid problems. Which one your surgeon chooses will depend on your specific condition.
Bone Removal
Your surgeon may recommend removing part or all of the sesamoid bone. When bone is removed from only one sesamoid, the other sesamoid bone can still provide a fulcrum point for the toe flexors. However, if both of the bones are taken out, the toe flexors lose necessary leverage and can't function. When this happens, the big toe will either bend up like a claw or slant severely toward the second toe. Thus, surgeons usually try to avoid taking both sesamoids out.
When a sesamoid bone is fractured in a sudden injury, surgery may be done to remove the broken pieces. To remove the sesamoid on the inside edge of the foot, an incision is made along the side of the big toe. The soft tissue is separated, taking care not to damage the nerve that runs along the inside edge of the big toe. The soft tissues enclosing the sesamoid are opened, and bone is removed. The tissues next to the sesamoid are stitched up. Then the soft tissues are laid back in place, and the skin is sewed together.
Surgery is similar for the sesamoid closer to the middle of the foot. The only difference is that the surgeon makes the incision either on the bottom of the big toe or in the web space between the big toe and the second toe.
Scraping
For patients diagnosed with stubborn plantar keratosis, surgeons generally perform surgery to scrape off the extra tissue. Your surgeon may decide to shave off only the affected part of the bone. The bottom half of the sesamoid is cut off, and the rough edges of the remaining part of the bone are filed with a special tool to leave a smooth shell. This surgery is easier on the body than procedures that completely remove the sesamoid.
Bone Graft
When patients continue to have problems with nonunion stress fractures, a bone graft may help the parts of the bone heal together. Surgeons mostly use this type of surgery for high performance athletes to keep the fulcrum point intact. The surgeon makes an incision along the inside edge of the main joint of the big toe. This exposes the sesamoid bone. The surgeon gathers small bits of bone from a nearby part of the big toe bone. The bone fragments are then packed into the unhealed area of the sesamoid. The soft tissue surrounding the sesamoid is stitched closed. Then the soft tissues are laid back in place, and the skin is sutured together.
Fractures can also cause pain in the sesamoids. Fractures can occur when a person falls and lands bluntly on the ball of the foot. Stress fractures can also occur in the sesamoid bones. Stress fractures are usually caused by the strain of overworking the soft tissues. Athletes most often suffer stress fractures of the sesamoids because of the heavy and repeated demands that training places on the soft tissues of the foot and big toe.
