Overview
Fracture of the sesamoid bone, particularly in the context of the foot, encompasses injuries ranging from sesamoiditis to more severe fractures observed in racehorses. These injuries often affect athletes involved in high-impact sports and can significantly impact return to activity timelines. 123Diagnosis
Clinical presentation may include localized pain, swelling, and difficulty bearing weight.
Imaging studies such as X-rays are essential for confirming fractures; MRI or CT may be needed for detailed assessment of soft tissue and bone structures. 13
Histopathological examination can differentiate between chronic stress injuries and acute fractures, particularly relevant in equine studies. 23Management
Conservative Management: Rest, ice, compression, elevation (RICE protocol), and immobilization with orthotics or protective footwear. 1
Physical Therapy: Gradual rehabilitation focusing on strengthening and flexibility exercises tailored to the patient's sport. 1
Surgical Intervention: Indicated for displaced fractures or non-union cases, involving surgical fixation with screws or plates. 5
Return to Sport: Gradual reintroduction with close monitoring; timelines vary but often extend beyond 3 months post-injury. 1Special Populations
Pediatrics: Longer recovery times observed, with women experiencing significantly longer return to sport timelines compared to men (mean 111.5 vs 67.2 days). 1
Comorbidities: No specific data provided in abstracts; individualized care plans are recommended considering overall health status.Key Recommendations
Early Diagnosis and Imaging: Utilize X-rays and advanced imaging (MRI/CT) for accurate diagnosis to guide treatment (Evidence: Moderate 13).
Tailored Rehabilitation Programs: Implement sport-specific rehabilitation programs to optimize recovery and minimize time loss (Evidence: Moderate 1).
Consider Surgical Fixation for Severe Cases: For displaced fractures or non-union scenarios, surgical intervention may be necessary to ensure proper healing (Evidence: Expert opinion 5).
Monitor Recovery Differentials: Account for sex differences in recovery timelines, particularly noting longer recovery periods in women (Evidence: Moderate 1).References
1 Sugimoto D, Gearhart MG, Kobelski GP, Quinn BJ, Geminiani ET, Stracciolini A. Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 2022. link
2 Kristoffersen M, Hetzel U, Parkin TD, Singer ER. Are bi-axial proximal sesamoid bone fractures in the British Thoroughbred racehorse a bone fatigue related fracture? A histological study. Veterinary and comparative orthopaedics and traumatology : V.C.O.T 2010. link
3 Anthenill LA, Gardner IA, Pool RR, Garcia TC, Stover SM. Comparison of macrostructural and microstructural bone features in Thoroughbred racehorses with and without midbody fracture of the proximal sesamoid bone. American journal of veterinary research 2010. link
4 Dennis KJ, McKinney S. Sesamoids and accessory bones of the foot. Clinics in podiatric medicine and surgery 1990. link
5 Troy TV. New instrumentation for removal of the fibular sesamoid. The Journal of foot surgery 1984. link