Sesamoids play an important function of the great toe
- absorb weight bearing pressure
- reduce friction
- protect tendons
Conditions affecting the Sesamoids
- Fracture
- Dislocation
- Inflammation
- trauma
- infection
- arthritic
- Chondromalacia
- Flexor hallucis brevis tendinitis
- Osteochondritis dissecans
History
- pain around great toe
- Pain after a sudden stop or snap after running
- pain on terminal extension of halluxin stance phase
- Neuritis
- digital nerve compression by oedema, inflammation or due to fractured sesamoid
Examination
- intractable plantar keratosis
- look for plantar flexed ray
- Neurology
Investigations
- AP and oblique X-rays
- medial oblique sesamoid view
- good for tibial sesamoid
- axial sesamoid view
- good for fibular sesamoid
- Bone Scan
- look for bipartite sesamoid
- MTP joint pathology
Treatment
Non-operative
- NSAID
- activity modification
- full-length shoe orthoses with a metatarsal pad
- metatarsal bar
- cast immobilisation
Operative
- Resection (partial or complete)
- shaving of prominent tibial sesamoid
- bone graft for nonunion
- Avoid excision of both sesamoids