Sesamoid Injuries Plague The AFL

Promising Collingwood draft pick Matthew Scharenberg and best and fairest winner from St Kilda Jack Steven have been sidelined for several weeks with two very similar pre-season injuries.

Both have been battling chronic sesamoid injuries during the pre-season. Scharenberg will undergo surgery to have the sesamoid bones in both his feet removed.

Jack Steven has just returned to football. He was cleared of any surgical intervention but missed 4-6 weeks with a fracture of the sesamoid bone in his right foot.

What are sesamoids?

A sesamoid is a bone located in a muscle tendon. In the foot, the sesamoids are two pea-shaped bones located in the ball of the foot, beneath the big toe joint. The sesamoids act as a lever for tendons, assisting the big toe to move normally and provide leverage during propulsion when walking or running.

Sesamoid injuries

Sesamoiditis: This is an overuse injury involving chronic inflammation of the sesamoid bones. Sesamoiditis often presents as a dull, longstanding pain beneath the big toe joint. The pain comes and goes, depending on certain footwear or certain activities.

Fracture: A fracture (break) in a sesamoid bone can occur in two different ways, either acute or chronic.

An acute fracture is caused by direct trauma – a blow or impact to the bone. Pain and swelling follows immediately at the site of the fracture.

A chronic fracture is a stress fracture (usually caused by repetitive stress or overuse).  These fractures produce longstanding pain in the ball of the foot beneath the big toe joint. The pain is generally aggravated with exercise and relieved with rest.

Non-Surgical Treatment

Non-surgical management for sesamoid injuries of the foot are as follows and more than one of these may be used, depending on the type of injury and degree of severity:

Padding or strapping – A pad may be placed in the shoe to offload the inflamed area, or the toe may be strapped to relieve that area of tension.

Immobilisation – The foot may be placed in a short leg cast or CAM walker to completely offload the area.

Oral medications – Anti-inflammatory drugs, such as ibuprofen, are often helpful in reducing the pain and inflammation but will not have a long-term effect on pain resolution.

Physical therapy. The rehabilitation process usually follows immobilisation and includes physical therapy, such as exercises (range-of-motion and strengthening.) and ultrasound therapy.

Steroid injections – In some cases, cortisone can be injected into the big toe joint to reduce pain and inflammation.

Orthotic devices – Custom-made orthotics may be prescribed for long-term treatment of sesamoiditis to offload the pressure placed on the ball of the foot.

When is Surgery Needed?

When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

If you are suffering from pain in your big toe/s, come and see our Melbourne Podiatrists for a thorough assessment. All injuries are resolved faster with early intervention, so don’t wait! Make your appointment today.