Tibial Sesamoid Position

The tibial sesamoid bones are small, oval-shaped structures located beneath the first metatarsal (the long bone in the foot). They play a crucial role in the movement and stability of the big toe, especially during activities like walking, running, and jumping. For some people, problems with the tibial sesamoid can cause significant pain and discomfort. This article explains the anatomy, function, and common issues related to the tibial sesamoid, particularly focusing on its position and the impact of any misalignments or injuries.

What Are Tibial Sesamoids?

The tibial sesamoids are part of the foot’s sesamoid bone system, which also includes the bones found in the hands and knees. These bones are embedded within tendons and serve to enhance the tendons’ ability to apply force. The tibial sesamoids are specifically located within the flexor hallucis brevis tendon, which helps move the big toe.

They act like pulleys, helping to transmit force from the muscles to the bones, thus enabling the smooth movement of the foot. When these bones are in their proper position, they allow for the efficient transmission of forces when pushing off the ground during activities like walking or running.

The Importance of Tibial Sesamoid Position

Proper alignment of the tibial sesamoids is vital for foot function. When the sesamoid bones are out of place, it can disrupt the mechanical function of the foot. A misalignment can lead to discomfort, pain, and even difficulty walking. This condition is particularly common in athletes or individuals who put repetitive stress on their feet, such as runners or dancers.

Common Conditions Linked to Tibial Sesamoid Misalignment

One of the most common conditions affecting the tibial sesamoids is sesamoiditis, which is inflammation of the sesamoid bones. This condition typically results from excessive pressure or repetitive stress on the foot. People with misaligned sesamoid bones may develop a painful condition where the bones no longer sit comfortably in their proper position. This can lead to significant discomfort, particularly during physical activity.

Another problem that can occur due to tibial sesamoid misalignment is sesamoid fractures. These fractures can be caused by trauma, excessive strain, or chronic stress. When a fracture occurs, it can be extremely painful, leading to difficulty with movement and a prolonged recovery period. In severe cases, surgical intervention may be required.

Assessing Tibial Sesamoid Position

To determine whether a tibial sesamoid is misaligned, a thorough assessment is essential. This typically includes a combination of physical examination, imaging techniques (such as X-rays or MRIs), and possibly diagnostic injections to pinpoint the source of pain. An experienced orthopedic surgeon can carefully evaluate the position of the tibial sesamoid and determine the best course of treatment.

Treatment Options for Tibial Sesamoid Issues

For individuals experiencing pain due to tibial sesamoid misalignment, there are several treatment options available. In mild cases, non-surgical treatments may include rest, ice therapy, anti-inflammatory medications, and changes in footwear to reduce stress on the foot. Orthotic devices, such as shoe inserts, may also help improve alignment and relieve pain.

For more severe cases, particularly those involving fractures or chronic misalignment, surgery may be required. One common surgical procedure is sesamoidectomy, which involves the removal of the problematic sesamoid bone. This procedure is typically considered when conservative treatments have failed, and it can be particularly beneficial for athletes looking to return to full activity.

Post-operative rehabilitation often includes physical therapy to restore strength and mobility to the foot, and patients can usually expect to return to normal activities within a few months, depending on the severity of the condition and the type of surgery performed.

Prevention of Tibial Sesamoid Issues

While some tibial sesamoid issues are due to factors beyond an individual’s control, such as genetics or traumatic injury, there are steps that can be taken to prevent misalignment and injury. Proper footwear is key—shoes that provide adequate support and cushioning can help absorb the impact on the foot, reducing the risk of strain on the sesamoid bones. Additionally, stretching exercises for the foot and ankle, as well as strengthening exercises for the surrounding muscles, can help maintain proper alignment and function of the tibial sesamoids.

Conclusion

The tibial sesamoid bones play a vital role in the function of the foot, and any issues with their position can lead to significant pain and discomfort. Whether caused by misalignment, trauma, or overuse, problems with these bones can be effectively managed with the right treatment. If you experience persistent foot pain, particularly around the big toe, it’s important to consult with an orthopedic specialist. A proper diagnosis and treatment plan can help you regain mobility and get back to your daily activities.

 

Do you have more questions?

Q. What are tibial sesamoids?
A. Tibial sesamoids are small, oval-shaped bones located beneath the first metatarsal in the foot, specifically within the flexor hallucis brevis tendon. They act as pulleys, assisting in the movement of the big toe and improving the efficiency of foot movement.

Q. Why is the position of the tibial sesamoid important?
A. Proper alignment of the tibial sesamoid is crucial for normal foot function. Misalignment can lead to pain, inflammation, and conditions like sesamoiditis or fractures, which can disrupt walking and cause difficulty in activities like running or jumping.

Q. What conditions are associated with misalignment of the tibial sesamoid?
A. Conditions include sesamoiditis (inflammation), sesamoid fractures, and misalignment leading to abnormal pressure on the foot, causing pain during physical activities or while walking.

Q. How is tibial sesamoid misalignment diagnosed?
A. Diagnosis is typically made through physical examination, X-rays, or MRI scans to determine the exact position of the sesamoid and assess the extent of any misalignment or damage.

Q. What treatments are available for tibial sesamoid misalignment?
A. Treatment options include conservative methods like rest, ice therapy, anti-inflammatory medications, and custom orthotics. In severe cases, surgical options such as sesamoidectomy may be recommended to remove the problematic bone.

Q. What is sesamoidectomy, and when is it needed?
A. Sesamoidectomy is a surgical procedure where the sesamoid bone is removed. It is typically performed when conservative treatments fail, and the pain caused by the sesamoid is persistent, especially in athletes or active individuals.

Q. How can tibial sesamoid issues be prevented?
A. Prevention includes wearing appropriate footwear with adequate arch support, stretching and strengthening exercises for the foot and ankle, and avoiding excessive strain on the foot through high-impact activities.

Q. How long does recovery take after sesamoidectomy surgery?
A. Recovery time varies, but most patients can expect to return to normal activities within a few months, with physical therapy helping to restore foot function and strength. Full recovery may take 3 to 6 months, depending on the individual.

Q. Can tibial sesamoid misalignment cause long-term foot problems?
A. Yes, if left untreated, tibial sesamoid misalignment can lead to chronic pain, deformities, and problems with foot function. Over time, this can result in conditions like arthritis or joint instability in the big toe.

Q. Can tibial sesamoid misalignment be treated without surgery?
A. Yes, mild cases of misalignment can often be managed with non-surgical treatments such as rest, custom orthotics, anti-inflammatory medications, physical therapy, and appropriate footwear modifications.

Q. What role do sesamoids play in walking and running?
A. Sesamoids act as pulleys for the tendons that control toe movement, which helps with push-off during walking and running. Misalignment can affect these movements, causing pain and instability during these activities.

Q. Are there any non-invasive treatments for tibial sesamoid issues?
A. Non-invasive treatments include the use of custom orthotics to redistribute pressure, padding to protect the sesamoids, ice therapy, rest, and modifying physical activities to reduce stress on the sesamoid area.

Q. Is surgery the only option if the tibial sesamoid is misaligned?
A. No, surgery is typically considered a last resort after conservative treatments fail. Surgery is usually recommended if the condition causes persistent pain or significantly affects foot function, such as during walking or sports.

Q. How can physical therapy help with tibial sesamoid issues?
A. Physical therapy can help strengthen the muscles around the foot and ankle, improve mobility, and correct abnormal gait patterns. It also aids in rehabilitation after surgery to restore full foot function.

Q. What can I do to reduce the risk of tibial sesamoid injury or misalignment?
A. To reduce the risk, wear supportive shoes with proper arch support, avoid overuse of the feet, engage in strengthening and flexibility exercises, and avoid high-impact activities without proper foot support.

Dr. Mo Athar
Dr. Mo Athar
A seasoned orthopedic surgeon and foot and ankle specialist, Dr. Mohammad Athar welcomes patients at the offices of Complete Orthopedics in Queens / Long Island. Fellowship trained in both hip and knee reconstruction, Dr. Athar has extensive expertise in both total hip replacements and total knee replacements for arthritis of the hip and knee, respectively. As an orthopedic surgeon, he also performs surgery to treat meniscal tears, cartilage injuries, and fractures. He is certified for robotics assisted hip and knee replacements, and well versed in cutting-edge cartilage replacement techniques.
In addition, Dr. Athar is a fellowship-trained foot and ankle specialist, which has allowed him to accrue a vast experience in foot and ankle surgery, including ankle replacement, new cartilage replacement techniques, and minimally invasive foot surgery. In this role, he performs surgery to treat ankle arthritis, foot deformity, bunions, diabetic foot complications, toe deformity, and fractures of the lower extremities. Dr. Athar is adept at non-surgical treatment of musculoskeletal conditions in the upper and lower extremities such as braces, medication, orthotics, or injections to treat the above-mentioned conditions.