Non-surgical Treatment for Sesamoid Injuries
Despite the many different causes of sesamoid pain, almost all are treated similarly to relieve symptoms. The patient is often treated with relative rest and restriction from running or other high-impact activities.
The patient may ice the toe area and also use anti-inflammatory medications. Wearing a stiff soled shoe or clog may decrease stress across the toe joint and rest the sesamoid bones. Alternatively, surgeons will sometimes prescribed a graphite or stainless steel insert to go into the shoe, sneaker, or athletic cleat to splint the joint in order to rest it.
Use of a specialized pad that takes pressure off the sesamoid can also alleviate pain. This can be an off-the-shelf pad that is inserted into the shoe or it can be incorporated into a custom-made prescription orthotic insole.
In the case of an acute fracture of the sesamoid, the patient may need to tape or strap the toe to decrease motion to allow the pieces to try to heal. This would usually be combined with the use of a stiff soled surgical shoe or fracture boot.
In rare cases, the surgeon may recommend a corticosteroid injection into the toe joint to decrease any inflammation.
Surgical Treatment for Sesamoid Injuries
If nonsurgical treatments are unsuccessful in relieving pain from a sesamoid problem, the orthopaedic surgeon may recommend surgical treatment as a more definitive course.
In the vast majority of cases, this entails a sesamoidectomy, which is surgical removal of the sesamoid bone. During this surgery, the surrounding ligaments and tendons are sutured back together to allow healing and restore strength of the toe for pushoff.
This surgery typically has a very high rate of pain relief and return to daily walking, running and sports; research studies have shown that even professional, collegiate or elite athletes can usually return to sports at their prior level after this type of surgery.
In rare cases, the surgeon may recommend a procedure to try to fix a broken or non-healed sesamoid fracture with use of bone grafting. Though the procedure is not typical, it is superior to simply removing the affected bone entirely.