Sesamoid Fractures
Most likely due to fall/jump from a height (ie crush, #) pushes sesamoids into plantar surface of metatarsal head.
Clinical features:
History of trauma;; pain on direct palpation and MPJ motion (especially dorsiflexion);
Differential – bipartite sesamoid (edges usually smooth); sesamoiditis; stress fracture; turf toe; plantar hyperkeratosis
On x-ray – fracture usually divides sesamoid into equal parts; has irregular borders and serrated edges; bone callous formation
If x0ray is not definitive bone scan, CT or MRI
Management:
Cast immobilisation; metatarsal bar; accommodative padding; rigid sole shoe.
After pain reduction soft cushioning insoles or running shoe
If prolonged pain surgical excision
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