Sesamoid Stress Fractures
It happens to everyone, you get a sudden urge to get fit, you increase a training load to reach that desired Personal Best, and you start a new job where you change from office desk jockey to trekking the pavement in shoes which were made for being a desk jockey. At first it’s a feeling of fatigue, your body, legs hurt, a couple of sharp pains here and here but hey, once you get home kick off the shoes, maybe walk on the carpet or put the feet up that pain subsides and you forget about it for another day.
Unfortunately, over the next 3-4 weeks that pain which once disappeared at the end of a long day is still around, the use of voltarin or ice packs are working less and less; the pain has finally come to a stage where you think “maybe it is time I see a professional about this”.
A stress fracture can be defined as a complete or partial continuity of bone. Stress fractures develop due to an overloading of a particular hard tissue structure where; increased forces lead to the stimulation of osteoclast activity and eventual bone resorption which outweighs the bone’s strengthening and adaption to stress by way of osteoblasts remodelling. This can occur due to a number of both intrinsic and extrinsic factors.
The sesamoids are found on the plantar aspect of the first MTP head, imbedded within the plantar plate. Of the three sesamoids of the first toe, these are the most likely to develop an injury. Sesamoid injury is responsible for approximately 9% of foot and ankle injuries and 1-2% of running injuries. Sesamoid pain is commonly localized but can be associated with joint aches, sharp stabs or irritating niggles.
A sesamoid stress fracture is considered a high risk injury due to poor blood supply, which requires a significant modification to activity and offloading of the area for a minimum of six weeks. If conservative treatment fails, surgical intervention may be deemed appropriate.
Until Next Time
Director/ Chief Editor