Sesamoid Fractures

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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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