Sesamoid bones of the foot are little pea-like bony structures that are associated with flexor tendons of the great toe, but are separate structures from them.
They provide a mechanical advantage so that the tendon can increase the power it is exerting. Usually there are two or three of these sesamoid bones distributed on the sole of the foot, but normally a person is not aware that they are even there. However, when they fracture or get irritated from trauma, the foot pain from them can become intolerable.
Standing foot X-rays with several views of the sesamoid bones of the foot will often help classifying where the problem lies. If this does not give all of the answers, sometimes a bone scan has to be ordered. There are a lot of variations of the normal pathology and there are other pathological abnormalities such as sesamoiditis, turf toe, which is a subluxation of the metatarsal head through a tear of the 1st MP joint and others. A CT scan or MRI scan can determine what ligament tear may have been caused. An orthopedic surgeon with an interest in foot surgery should be consulted, before any surgery would be planned. Treatment may consist of splinting and active therapy to maintain function. Unfortunately with aggressive surgery of the sesamoid bones and removal of both the medial and lateral one, a claw toe deformity with intractable pain can be created, which will not respond to any further therapy. Most orthopedic surgeons prefer a more conservative approach.
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.
3. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 60, p.487.
5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008