This is inflammation of the sesimoid bones which results in pain behind the big toe of the foot. The sesimoid bones are extremely important functionally as they protect and serve as a fulcrum for the flexor hallucis longus tendon which bends the big toe. Additionally the seisimoid bones absorb most of your weight on inner aspect of the forefoot. Injury to the sesimoid bones can occur due to excessive force resulting from the sudden bending upwards of the big toe, landing from a height after a jump or repetitive forefoot weight bearing activities such as sprinting and dancing. Patients will complain of pain behind the big toe during weight bearing activity and will often walk on the outside edge of their foot to avoid placing pressure through the big toe.
Physiotherapy treatment involves the use of orthotics, padding and/or tape to help redistribute weight away from the big toe. In cases where as sesimoid stress fracture is suspected it is important that an MRI is arranged immediately as these stress fractures are prone to non-union. If a stress fracture is confirmed by MRI a patient will be placed into a non-weight bearing cast or boot for up to six weeks. Depending on how well the fracture site is healing fixation of the bone with a screw may be necessary.