Physical Therapy in Congress Park, Denver Downtown, Central Park, and Highlands Area for Foot
Welcome to Atlas Physical Therapy's patient resource in Congress Park, Denver Downtown, Central Park, and Highlands Area about Sesamoid Problems.
Two pea-sized bones, called sesamoids, are embedded within the soft tissues under the main joint of the big toe. Even though they are small in size, the sesamoids play an important role in how the foot and big toe work. If the sesamoids are injured, they can be a source of severe pain and disability.
This article will help you understand:
how the sesamoid bones in the foot work
how sesamoiditis develops
what can be done for the condition
Hear from some of our Foot Therapy patients
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Atlas Physical Therapy is the best! I came in with a sprained ankle and the staff was super patient and helpful as we worked through the injury. Brett and Will were amazing and I would recommend them... ”
“ Atlas Physical Therapy is the best! I came in with a sprained ankle and the staff was super patient and helpful as we worked through the injury. Brett and Will were amazing and I would recommend them to anyone! The downtown location is super convenient for anyone who works down there too! ”
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By far the best physical therapists I have ever gone to! Alex and Kate have fixed everything that has come up from foot issues, to knee problems to all the tiny little things that happen during... ”
“ By far the best physical therapists I have ever gone to! Alex and Kate have fixed everything that has come up from foot issues, to knee problems to all the tiny little things that happen during training or just life in general. Lexi and Emma are awesome at making sure im doing exercises correctly and making it fun at the same time. With the help of everyone at Atlas Physical Therapy I was able to complete my first ultramarathon and look forward to completing many other ridiculous goals. ”
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I had been referred to Alex at Atlas by several different people, but it ended up being my daughter's plantar fasciitis that finally got us in there. He did absolutely great with her really does well... ”
“ I had been referred to Alex at Atlas by several different people, but it ended up being my daughter's plantar fasciitis that finally got us in there. He did absolutely great with her really does well with kids. I don't have any acute injuries at this point, but while I was in there with her, I asked about various ongoing issues/problem areas I have, and ended up beginning treatment with him as well. He takes a well rounded and very practical approach that for us has included tissue work (both), dry needling (me), ultrasound (her), adjustments (me), and obviously various exercises and stretches. The rest of the staff there is great as well. Highly recommend. ”
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I am a runner and runners sometimes get hurt! Alex has magic hands. The man has helped me get through plantar fasciitis on both feet, hip and knee issues and a pulled hamstring! All while keeping it... ”
“ I am a runner and runners sometimes get hurt! Alex has magic hands. The man has helped me get through plantar fasciitis on both feet, hip and knee issues and a pulled hamstring! All while keeping it fun and just being an amazing coach. If something ails you- go see him! He has magic hands and will get you back on track in no time ”
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I’ve been going to Atlas for a couple of months to work on some issues with my peroneal and Achilles, and I’ve been thoroughly impressed with every single person who works at Atlas. I’ve worked... ”
“ I’ve been going to Atlas for a couple of months to work on some issues with my peroneal and Achilles, and I’ve been thoroughly impressed with every single person who works at Atlas. I’ve worked with at least 5 people here, and they have all been knowledgeable, helpful, friendly, caring and cool. They remember who I am every time I come back, have been great at listening and helping with my recovery, and I quite honestly look forward to each visit. I’ve been getting dry needling done lately, and I was pretty afraid since I hate needles. Both Kate and Amanda have done an excellent job however with minimal discomfort and great results afterwards. I’m happy to have discovered Atlas, and I’ve been recommending it to friends and family. ”
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Heather is great! She took me from barely walking to being able to run again. I broke/dislocated my ankle last year and started seeing Heather once I was weight bearing again. I wouldn’t have... ”
“ Heather is great! She took me from barely walking to being able to run again. I broke/dislocated my ankle last year and started seeing Heather once I was weight bearing again. I wouldn’t have gotten to the point I’m at now without her! ”
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This place is great. I worked with Alex for a little over a month. I visited several PT's prior to meeting with Alex all of whom suggested to remove screws post ankle surgery. With Alex's help, I was... ”
“ This place is great. I worked with Alex for a little over a month. I visited several PT's prior to meeting with Alex all of whom suggested to remove screws post ankle surgery. With Alex's help, I was able to avoid a second surgery, AND am now feeling like I did before the injury. Thanks Alex ”
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Amazing place, awesome team! I broke my ankle in January and had surgery a day later. About 7 weeks after that, I started physical therapy at Atlas and I could not have been happier. I was... ”
“ Amazing place, awesome team! I broke my ankle in January and had surgery a day later. About 7 weeks after that, I started physical therapy at Atlas and I could not have been happier. I was ’assigned’ to work with Kate as my PT and she was fantastic. She worked closely with me on movement, strengthening, massaging and flexibility in order to getting me back to my normal self and activities. At times, I even felt bad for her, because I am very ticklish so working on my foot wasn’t always the easiest thing for her, but she took it like a champ; she even did a great job of distracting me in order for her to work on my ankle issues. The exercises I was instructed to do were super helpful, and I was able to do them both at home and at the facility (along with many more when I was there). I loved how I was able to work with multiple staff members while working out my ankle and everyone pushed me to keep going and never made me feel bad if I wasn’t able to complete something, but rather said it was okay and we would try again the next time I came in. No matter the time of day or how busy they were, everyone said hello to you, by name, when you walked in making you feel very welcomed. Although I have recently graduated, I will sporadically go back so I can have Kate continue to help me recover, get new exercises for strength, and to just say hello to the staff. I could not be more happy with my recovery and the awesome people at Atlas who helped make it happen. ”
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Laura has been a godsend for me and has helped put me back together more than once! I came in when I was pregnant for a hip issues, then post pregnancy for a foot issue. Both situations I was treated... ”
“ Laura has been a godsend for me and has helped put me back together more than once! I came in when I was pregnant for a hip issues, then post pregnancy for a foot issue. Both situations I was treated wonderfully by the administrative staff and the physical therapist. The new location is key, parking is ample. The are communicative, timely and most importantly, work wonders on what ails you! ”
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I’ve been impressed and very satisfied with Atlas Physical Therapy ever since I started seeing them after a foot surgery in 2021. When I returned a year or so later in 2022 I worked closely with... ”
“ I’ve been impressed and very satisfied with Atlas Physical Therapy ever since I started seeing them after a foot surgery in 2021. When I returned a year or so later in 2022 I worked closely with Andrea and Nate. Not only were they fantastic to work with, they were excellent listeners and very effective at finding the best treatment to alleviate my issues. I highly recommend using them for your PT needs! ”
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Am 77 years old and started seeing Lexi at the Stapleton location for strengthening of an achilles tendon injury, core strength training, and flexibility and balance training. Lexi was very sensitive... ”
“ Am 77 years old and started seeing Lexi at the Stapleton location for strengthening of an achilles tendon injury, core strength training, and flexibility and balance training. Lexi was very sensitive to all of my needs and concerns and included all of the areas that I wanted to improve upon in each workout. I have improved significantly in each of those areas and Lexi has given me a series of exercises and stretches to maintain and continue to build on my own. I highly recommend Lexi to anyone seeking to improve themselves in a serious yet fun environment. ”
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I am really grateful to Alex and his crew, they helped me with an ankle injury and my back issues. He helped strengthen and rehabilitate my ankle, while leaving me feeling like he was really... ”
“ I am really grateful to Alex and his crew, they helped me with an ankle injury and my back issues. He helped strengthen and rehabilitate my ankle, while leaving me feeling like he was really invested in my recovery. When we had reached a point where I was still having some pain but he had done all that he could, he didn’t just keep taking my money, he made a suggestion for a doctor that might be able to help me further. I recommend them regularly and will be back with any future injuries. ”
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I’ve struggled for seven years with ankle pain since tearing a ligament, and also developed really bad runner’s knee while training for my first half marathon last year. The only other time... ”
“ I’ve struggled for seven years with ankle pain since tearing a ligament, and also developed really bad runner’s knee while training for my first half marathon last year. The only other time I’d been to physical therapy for a previous injury, the results were temporary. Alex at Atlas PT explained the ’why’ behind my pain, gave me detailed exercises and therapy that were doable, I noticed results immediately... and four years later, I can still run, hike, and ski again without pain. ”
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Hey! I’ve been working with Alex Lanton following two surgeries on my foot. He’s so smart, fun, and effective. I would never go anywhere else for my PT needs. ”
“ Hey! I’ve been working with Alex Lanton following two surgeries on my foot. He’s so smart, fun, and effective. I would never go anywhere else for my PT needs. ”
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My daughter saw Nikhil to address ankle pain due to hypermobility. He was great at quickly identifying the issue, explaining it, and prescribing easy and effective exercises that helped very quickly.... ”
“ My daughter saw Nikhil to address ankle pain due to hypermobility. He was great at quickly identifying the issue, explaining it, and prescribing easy and effective exercises that helped very quickly. Great experience. ”
The main joint of the big toe forms the inside edge of the ball of the foot. The two small sesamoid bones are located on the underside of this joint. There is one sesamoid bone on each side of the base of the big toe.
Sesamoid Bones
One Sesamoid Bone (on each side)
The muscles that bend the big toe down (the toe flexors) pass underneath the main joint of the big toe, crossing over the bump formed by the sesamoid bones. This bump acts as a fulcrum point for the toe flexors, giving these muscles extra leverage and power. The sesamoids also help absorb pressure under the foot during standing and walking, and they ease friction in the soft tissues under the toe joint when the big toe moves.
Sesamoid pain can develop a number of different ways. When the tissues around the sesamoid bones become inflamed, doctors call the condition sesamoiditis. Sesamoiditis is often caused by doing the same types of toe movements over and over again, which happens in activities like running and dancing.
Fractures can also cause pain in the sesamoids. Fractures can occur when a person falls and lands bluntly on the ball of the foot. Stress fractures can also occur in the sesamoid bones. Stress fractures are usually caused by the strain of overworking the soft tissues. Athletes most often suffer stress fractures of the sesamoids because of the heavy and repeated demands that training places on the soft tissues of the foot and big toe.
Arthritis can develop where the sesamoids glide under the bone of the big toe. The sesamoid bones create a joint where they move against the bone of the big toe. Like other joints in the body, this joint can also develop arthritis. Arthritis is more likely to be a problem in people who have high arches in their feet. The high arch causes the main joint of the big toe to become rigid. This focuses strain and pressure on the sesamoids.
In some cases, blood supply to the sesamoid bone is decreased. This condition is called osteochondritis. Osteochondritis causes a piece of the bone to actually die. The body's attempts to heal the area may build up extra calcium around the dead spot.
Sometimes sesamoid pain comes from extra tissue under the big toe joint, similar to a corn. Doctors call this extra tissue an intractable plantar keratosis.
Plantar Keratosis
Symptoms
What does sesamoiditis feel like?
People with sesamoid problems usually feel vague pain under the main joint of the big toe. The sesamoids typically feel tender when touched. Movement of the big toe is often limited. People tend to notice pain mostly when their big toe is stretched upward, which can happen when the back foot pushes off for the next step. Occasionally the joint catches or pops. The catching or popping is often followed by increased pain, which usually eases after resting. Some people report feelings of numbness in the web of the first two toes.
Toe Stretched Upward
Diagnosis
How do health care providers identify this problem?
When you first visit Atlas Physical Therapy, our Physical Therapist will ask many questions about your medical history. We’ll ask you about your current symptoms and whether you've had other foot and joint problems in the past. Our Physical Therapist will then examine your painful toe by feeling it and moving it. This may hurt, but it is important that we locate the source of the pain and determine how well the toe is moving. You may also be asked to walk back and forth.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at Atlas Physical Therapy have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Our Treatment
What can be done for the condition?
Many cases of sesamoiditis can heal completely with careful treatment. There are two methods for treating sesamoid problems, nonsurgical treatment and surgery. Surgery is most often used as a last resort, when other forms of treatment aren't helping.
Non-surgical Rehabilitation
Although each patient recovers at a different rate, as a general rule, our patients with sesamoid problems typically undergo four to six Physical Therapy treatments. Your Physical Therapist can offer ideas of pads or cushions that help take pressure off the sesamoid bones. We may recommend that special padding in the shape of a J can be placed inside your shoe to ease pressure on the sesamoids as you stand and walk. You may need to limit the amount of weight placed on your foot when you're up and about. Shoes with low heels may also ease the pressure. Your doctor may also recommend supplementing rehabilitation with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.
Our Physical Therapist may apply treatments to the painful area to help control pain and swelling, such as ultrasound, moist heat, and soft-tissue massage. Our Physical Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory drugs, prescribed by your doctor, into the sore area.
If simple modifications are made to your shoes you may be allowed to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside. If we must use more aggressive treatment during your recovery, you may be required to use crutches for several weeks to keep weight off the foot.
Post-surgical Rehabilitation
After a surgical procedure to shave or remove bone, patients are generally placed in either a rigid-soled shoe or a cast for two to three weeks. We will help you learn to properly use crutches to limit the weight that you put on your foot during the early stages of your recovery.
Treatment is more cautious after bone graft surgery. Patients usually wear a cast for up to four weeks. Then they wear a short walking cast for another two months, at which time active exercises can start.
The Physical Therapists at Atlas Physical Therapy can develop a personalized Physical Therapy program to help speed your rehabilitation. When your recovery is well under way, regular visits to Atlas Physical Therapy will end. Although we will continue to be a resource, you will eventually be in charge of doing your exercises as part of an ongoing home program.
Atlas Physical Therapy provides services for Physical Therapy in Congress Park, Denver Downtown, Central Park, and Highlands Area.
Surgery
If surgery becomes necessary, several procedures are available to treat sesamoid problems. Which one your surgeon chooses will depend on your specific condition.
Bone Removal
Your surgeon may recommend removing part or all of the sesamoid bone. When bone is removed from only one sesamoid, the other sesamoid bone can still provide a fulcrum point for the toe flexors. However, if both of the bones are taken out, the toe flexors lose necessary leverage and can't function. When this happens, the big toe will either bend up like a claw or slant severely toward the second toe. Thus, surgeons usually try to avoid taking both sesamoids out.
When a sesamoid bone is fractured in a sudden injury, surgery may be done to remove the broken pieces. To remove the sesamoid on the inside edge of the foot, an incision is made along the side of the big toe. The soft tissue is separated, taking care not to damage the nerve that runs along the inside edge of the big toe. The soft tissues enclosing the sesamoid are opened, and bone is removed. The tissues next to the sesamoid are stitched up. Then the soft tissues are laid back in place, and the skin is sewed together.
Surgery is similar for the sesamoid closer to the middle of the foot. The only difference is that the surgeon makes the incision either on the bottom of the big toe or in the web space between the big toe and the second toe.
Scraping
For patients diagnosed with stubborn plantar keratosis, surgeons generally perform surgery to scrape off the extra tissue. Your surgeon may decide to shave off only the affected part of the bone. The bottom half of the sesamoid is cut off, and the rough edges of the remaining part of the bone are filed with a special tool to leave a smooth shell. This surgery is easier on the body than procedures that completely remove the sesamoid.
Bone Graft
When patients continue to have problems with nonunion stress fractures, a bone graft may help the parts of the bone heal together. Surgeons mostly use this type of surgery for high performance athletes to keep the fulcrum point intact. The surgeon makes an incision along the inside edge of the main joint of the big toe. This exposes the sesamoid bone. The surgeon gathers small bits of bone from a nearby part of the big toe bone. The bone fragments are then packed into the unhealed area of the sesamoid. The soft tissue surrounding the sesamoid is stitched closed. Then the soft tissues are laid back in place, and the skin is sutured together.
Fractures can also cause pain in the sesamoids. Fractures can occur when a person falls and lands bluntly on the ball of the foot. Stress fractures can also occur in the sesamoid bones. Stress fractures are usually caused by the strain of overworking the soft tissues. Athletes most often suffer stress fractures of the sesamoids because of the heavy and repeated demands that training places on the soft tissues of the foot and big toe.
