Sesmoids play an important function of the great toe
- absorb weight bearing pressure
- reduce friction
- protect tendons
Conditions affection 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
- Neurolgy
Investigations
- AP and oblique Xrays
- 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
Nonoperative
- NSAID
- activity modification
- full-lebgth shoe orthoses with a metatarsal pad
- metatarsal bar
- cast immobilization
Operative
- Resection (partial or complete)
- shaving of prominent tibial sesamoid
- bone graft for nonunion
- Avoid excision of both sesamoids