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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.
How do you treat sesamoid injuries?
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.
What do you do then?
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.