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Sesamoid Fracture
Aka: Sesamoid Fracture
- Background
- Sesamoids: Two flat bones at plantar first MTP
- Medial sesamoid is more commonly injured than lateral
- Mechanisms of injury
- Trauma due to falls
- Great toe hyperextension
- Metatarsophalangeal joint (MTP) dislocation
- Stress Fracture of sesamoid
- Signs
- Pain on palpation of plantar first Metatarsal head
- First toe extension refers pain to plantar 1st MTP
- Radiology
- Foot XRAY AP and lateral
- Fracture usually found on xray
- Sesamoid partition is a common normal variant
- May be difficult to distinguish from Fracture
- Management
- Consider arch supports in mild cases
- Short Leg Walking Cast for 4 weeks in most cases
- Follow-up with Metatarsal supports after Casting
- Refractory pain after Casting
- Local Corticosteroid Injection
- Orthopedic referral for sesamoid resection (uncommon)
- Complications
- First MTP Degenerative Joint Disease
- Nonunion Fracture
- Course
- Anticipate persistent symptoms for up to 6 months
- References
- Delee (2003) Orthopaedic Sports Med, p. 2512-14
- Marx (2002) Rosen's Emergency Medicine, p. 731