Sesamoid Fracture / Sesamoiditis

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Patient Information

https://orthoinfo.aaos.org/en/diseases–conditions/sesamoiditis

GP Information

Background Information

  • The sesamoids are 2 small bones underneath the MTPJ of the big toe and may fracture following trauma or become painful with overload.
  • Patients typically complain of pain under the ball of the big toe +/- swelling and bruising with difficulty on flexing and extending the big toe.
  • Examination may reveal tenderness to direct palpation, worse on passive ROM.

Investigation Guidelines

  • An XR is typically required to confirm the diagnosis.

Management Recommendations

Conservative measures include

  • PRICE
  • NSAIDs
  • Consider taping the joint to restrict painful motion.
  • A heel-weight-bearing shoe or orthotic may provide comfort whilst the fracture heals. Discomfort typically subsides after 6-8 weeks.

Referral Indications;

  • Diagnostic uncertainty.
  • Failure of conservative measures after a minimum of 6 weeks.
  • Results of diagnostics indicate specialist assessment required.