Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Sesam Bone Stress Fractures

SYMPTOMS

There is gradually increasing exerciseinduced pain and swelling around and below MTP I or diffuse pain in the forefoot on forefoot landings and running.

AETIOLOGY

This injury is usually caused by excessive direct impact from landing on the forefoot on hard surfaces.

CLINICAL FINDINGS

There is distinct tenderness on palpation over the medial or lateral sesam bones during forced dorsi-flexion of toe extensors. Jumping and landing on the forefoot is very painful.

INVESTIGATIONS

X-ray is often normal until later stages or if avascular necrosis or sclerosis occurs. MRI may show oedema in and around the sesam bone and occasionally, in late stages, avascular necrosis. CT scans can sometimes show the fracture line.

TREATMENT

Initially try orthotics or soft padding to take the load off the sesam bones. NSAID or local cortisone injections can give short-term relief. Surgery for excision of the fractured fragments or of the fractured bone may be necessary.

REFERRALS

Refer to podiatrist or physiotherapist for mild symptoms and to orthopaedic foot surgeon if symptoms become severe.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes and avoiding impact to the forefoot. Suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs.

PROGNOSIS

Excellent if treated appropriately but duration of symptoms can be long after surgery.

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