Sesamoid Injury Treatment in Los Angeles

What is a Sesamoid?

The sesamoid bones are two small, solitary bones situated underneath the first metatarsal (the first long bone) just behind the big toe (hallux). Each sesamoid has a joint with the first metatarsal above it. These bones are wrapped inside and held in place by the tendon that functions to pull the toe downward during gait (flexor hallucis longus). Some individuals are born with one or both sesamoids in two or more pieces.

The sesamoids are the tibial (or medial) and fibular (or lateral) sesamoids. They help absorb significant pressure when bearing weight through the foot. However, these bones do not have a strong blood supply, making them susceptible to injury.

If you’re experiencing sesamoid pain, seeking the best sesamoid treatment in Los Angeles from Dr. Soomekh is essential to prevent long-term damage.

What is Sesamoiditis?

Inflammation

When a sesamoid bone experiences direct trauma or repetitive micro-injury, it can become inflamed, bruised, and irritated — a condition known as sesamoiditis (-itis = inflammation). This condition is painful because the injured bone is continually pressed when walking.

Sesamoids that are naturally in two or more pieces (bipartite sesamoids) have a slight bony or soft tissue connection between the pieces. Injury can tear this connection, leading to inflammation and pain.

Fracture

Signs and Symptoms of Sesamoiditis

Most patients describe:

• A deep ache and sharp pain in the ball of the foot just behind the big toe
• Pain in the big toe joint
• No pain at rest, but discomfort, increasing with activity
• Some days are more painful than others due to inflammation and bruising
• Numbness in the ball of the foot due to nerve irritation
• Possible arthritis development in the sesamoid joint, causing joint pain when walking
• Increased discomfort in certain shoes, especially when walking barefoot

Causes of Sesamoiditis

Damage to the sesamoids is primarily caused by injury, which may be:

• A direct injury, such as a basketball player landing hard on the ball of the foot after a jump
• Repetitive micro-injuries, such as a runner constantly putting pressure on the ball of the foot
• Biomechanical issues, including:
  

• High-arched feet (pes cavus, supination), which create excess pressure on the sesamoids
  
• Bunion deformities (hallux abducto valgus), which misalign the sesamoids and lead to improper pressure distribution
  
• Long-term use of high heels, which forces additional pressure onto the sesamoids
  

If you're dealing with any of these issues, consulting the best podiatrist in Los Angeles can provide relief and prevent further damage.

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Diagnosing Sesamoiditis

Dr. Soomekh’s diagnosis of sesamoiditis is accomplished through:

• A clinical examination at our state-of-the-art Beverly Hills office
• X-rays to assess the condition of the sesamoid bones
• Comparison X-ray of the unaffected foot (if a bipartite sesamoid is suspected)
• MRI or in-office CT scan, if necessary, to check for avascular necrosis (AVN) or blood supply loss

Dr. Soomekh, recognized as the best sesamoid doctor in Los Angeles, will conduct a thorough evaluation to determine the best course of treatment.

Sesamoiditis Treatment Options

Dr. Soomekh emphasizes that early diagnosis and treatment are essential for a successful recovery and a pain-free lifestyle.

Conservative Treatment for Sesamoiditis

Sesamoids are difficult to heal due to the constant pressure patients endure with every step, along with their poor blood supply, which limits healing. Conservative treatment focuses on removing the stress on the sesamoids and reducing inflammation. Treatment options include:

• Activity modification, reducing weight-bearing activities to allow healing
• Supportive footwear, such as cushioned shoes to relieve pressure
• Walking boot, worn for three to six weeks to offload pressure
• Crutches, in rare cases, to completely offload the foot
• Rest, ice therapy, and NSAIDs to reduce swelling and inflammation
• Physical therapy to improve mobility and healing
• Custom orthotics to correct biomechanical issues and prevent future injuries
• Steroid injections, which are of limited value due to potential side effects in this area

If conservative measures fail, surgical intervention may be necessary.

Surgical Treatment for Sesamoiditis

Dr. Soomekh prioritizes conservative treatments but will recommend surgery when necessary. Sesamoid surgery is not typically painful during recovery when performed with careful, precise techniques.

Goals of Sesamoid Surgery

• Remove the damaged sesamoid
• Alleviate pain
• Restore normal function
• Allow a return to normal footwear and activities

Most procedures allow for immediate walking and a return to work while wearing a special walking boot. Surgeries are performed in an outpatient setting at state-of-the-art facilities.

Removing the Sesamoid

• A small incision is made:
  

• On the side of the big toe joint for the medial sesamoid
  
• On the bottom of the big toe joint for the lateral sesamoid
  

• The sesamoid is carefully released from its attachments to the tendon and ligaments
• Tendon and ligament repairs are made as needed
• A regenerative human umbilical cord graft (Amniox®) may be applied to reduce scar tissue
• The incision is closed using plastic surgery techniques for optimal healing