The big toe is a mystery. Though tiny in size, it is able to withstand enormous amounts of pressure and weight; it even provides balance the body needs. This small yet powerful structure works hard to propel us forward while walking running and jumping. The big toe holds a lot of responsibility as it is one of the three sesamoid bones found in the body. Besides the patella and the bone located in the middle of the foot, the kernel sized sesamoid bone located at the forefront of the foot attaches to the big toe.
So what is a sesamoid? It is a bone that is not connected to any other bone in your body. Most bones in the body are connected to other joints, but not the big toe. These sesamoids are connected only to tendons or embedded muscles found within the body. Because of their pulley-like actions, their main job includes creating a smooth surface for tendons to slide. This movement improves the ability of the tendons to transmit muscles forces.
Because of these repetitious movements, the sesamoids have the ability to break or fracture. Sometimes, the tendons encompassing the sesamoid become irritated or inflamed. This is known as "sesamoiditis" which is a form of tendonitis. This condition usually plagues dancers, runners and professional athletes.
Symptoms of Sesamoiditis
Pain is the largest symptom associated with a sesamoid injury. Pain is typically located under the big toe and develops gradually. If a fracture is present, the pain is immediate. Pain while bending or straightening the big toe is a good indication that a sesamoid injury is present. Swelling and bruising may or not be present. These conflicting symptoms sometimes make a diagnosis more challenging. If rest has not improved the condition of your toe, you should consult a qualified physician for a more thorough evaluation.
During a physical examination, your physician will look for tenderness near the big toe and sesamoid bones. Often the physician will manipulate the toe by bending or straightening the bone to see where the pain is located. X-rays can be used to properly diagnose the problem further. Rarely, a bone scan is requested as well as a blood test, if the X-ray appears normal.
Once the diagnosis has been confirmed as a sesamoid injury to the big toe, the treatment includes rest and avoiding the specific injury that causes the pain. The use of anti-inflammatory medicines and applying ice to the big toe are likely necessary to treat this area. Sometimes, taping the toe or wearing a cushioning pad in soft-soled shoes may help to take the pressure off the area. If the symptoms remain after four to six weeks, your orthopedic physician may recommend wearing a removable short leg fracture brace to rest your entire foot.
The medical treatment for a sesamoid injury is fairly mild, and mostly involves reducing the pressure to this area by limiting activity and resting. Left untreated, the pain in this area could become severe and may result in a fracture to the sesamoid bone. This injury could cause a lot of pain and this area is important to complete many functions. Remember: the big toe has big responsibilities; don't let this pain go untreated.
Dr. Stacie L. Grossfeld is a board certified Orthopaedic Surgeon
practicing in Louisville, Kentucky. She graduated from the University of
Louisville School of Medicine, and completed a fellowship in Sports
Medicine at the Fowler-Kennedy Sports Medicine Center. Dr. Grossfeld
currently works as a louisville orthopedic surgeon in private practice
at Orthopaedic Specialists. Dr. Grossfeld also serves as a clinical
instructor in the Department of Orthopaedic Surgery at the University of
Louisville. Her special interests are in knee and shoulder
reconstruction and sports medicine. Learn more about her orthopedic medical practice.
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