My Big Toe Joint Hurts!

A sesamoid is a bone embedded in a tendon. Sesamoids are found in several joints in the body. In the normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint.
Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe pushes off during walking or running. The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe), absorbing the weight placed on the ball of the foot when walking, running, and jumping.

Sesamoid injuries can involve the bones, tendons, and/or surrounding tissue in the joint. They are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.
There are three types of sesamoid injuries in the foot:

• Turf toe. This is an injury of the soft tissue surrounding the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range. Turf toe causes immediate, sharp pain, and swelling. It usually affects the entire big toe joint and limits the motion of the toe. Turf toe may result in an injury to the soft tissue attach to the sesamoid or a fracture of the sesamoid. Sometimes a pop is felt at the moment of injury. 
• Fracture. A fracture in a sesamoid bone can be either acute or chronic. An acute fracture is caused by trauma- a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint. A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces longstanding pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, is generally aggravated with activity and relieved with rest.
• Sesamoiditis. This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure to the sesamoids. Often, sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.

In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the big toe joint. The surgeon will press on the big toe, move it up and down, and may assess the patient's walking and evaluate the wear pattern on the patient's shoes. X-rays are ordered, and in some cases, advanced imaging studies may be ordered.
Non-surgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:

• Padding, strapping, or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension. 
• Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
• Physical therapy. The rehabilitation period following immobilization sometimes includes physical therapy, such as exercises (range-of-motion, strengthening, and conditioning), and ultrasound therapy. 
• Steroid injections. In some cases, cortisone is injected in the joint to reduce pain and inflammation. 
• Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.

When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The podiatrist will determine the type of procedure that is best suited to the individual patient.
If you are an athlete suffering from a sesamoid injury or any other sports injury, call our Newington, Kensington, or Middletown office to make an appointment.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.

Turf Toe Injury

Turf toe is a sprain of the big toe joint resulting from injury during sports activities. The injury usually results from excessive upward bending of the big toe joint. The condition can be caused from either jamming the toe, or repetitive injury when pushing off repeatedly when jumping or running. Although this injury is most commonly reported in football players, participants in soccer, basketball, wrestling, gymnastics, and dance are also at risk.

The name turf toe comes from the fact that this injury is especially common among athletes who play on artificial turf. When playing sports on artificial turf, the foot can stick to the hard surface, resulting in jamming of the big toe joint. There has also been some indication that less-supportive flexible shoes worn on artificial turf are also to blame.
The signs and symptoms of turf toe can include pain, swelling, and limited joint movement.
If turf toe is caused by repetitive actions that cause injury, the signs and symptoms will usually begin slowly and gradually worsen. Turf toe can also be caused by a direct injury leading to damage of the bone beneath the cartilage. If direct injury is the cause, the signs and symptoms may begin suddenly and get worse over a 24 hour period.
To arrive at a diagnosis, the podiatrist will obtain your medical history and examine your foot. X-rays are typically ordered to rule out any broken bone. Other advanced imaging studies may also be helpful for proper diagnosis.
Initial treatments include R.I.C.E., as well as a change to less-flexible footwear. Operative treatment is reserved for individuals with severe cases and prolonged pain.
If you are an athlete suffering from turf toe or any other sports injury, call our Newington, Kensington, or Middletown office to make an appointment.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in CT
Podiatrist in Newington, Kensington, and Middletown, CT
Visit our website, friend and like our page on Facebook, and follow my tweets on Twitter.