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What is a sesamoid?

From the Greek word for "Similar To A Sesame Seed", the word Sesamoid refers to two small bones you have in the ball of the foot beneath and behind your big toe joint. (You also have them in your thumb joint, but we're not concerned about those sesamoids here.)

What do sesamoids do?

The sesamoids act like pulleys, to help and improve the efficiency and function of the flexor tendons (the tendons on the bottom of the foot which help bend your big toe down).

Your knee cap (patella) functions in the same way, and can be thought of as large sesamoids.

The two small, circular bones behind the big toe are the sesamoid bones

Seen from the view on the right, the sesamoids are clearly seen beneath the first metatarsal bone:

So what can go wrong with your sesamoids?

The most common thing to go wrong is the development of sesamoiditis, a condition where the sesamoids become inflamed, usually from repetitive trauma.

If the sesamoids are traumatized past the point of simple irritation, they may become break, a condition known as a fractured sesamoid. This condition has to be differentiated from that of bipartite sesamoids, a normal variant where instead of two sesamoids, a patient may have sesamoids made up of multiple pieces. As you might imagine, this can look very similar to a fractured sesamoid, so a thorough assessment by a foot specialist is essential to accurately diagnose the problem.

We have a fairly large arsenal of treatments that can be employed to treat sesamoiditis. Rest, ice, compression, elevation, padding, orthoses, medications, shoe changes, physiotherapy and other treatments have been used successfully for this condition.

The difficulty, however, is that the sesamoids have very poor blood supply, and coupled with the forces exerted on the bones from weight bearing and from the pull of the tendons, sesamoids often heal very slowly. Sometimes they don't heal at all, despite proper diagnosis and treatment.

If they're painful and don't respond to treatment, the problem sesamoid may have to be removed. While this may seem simple, sometimes the toe begins to drift in one direction or the other after the surgery (depending upon which sesamoid is removed), and additional procedures may have to be considered to stabilize the toe.