Foot

What It Is

Sesamoid fractures are difficult to understand unless you know what the sesamoid bones are. These are tiny bones that are not joined to other bones at a joint; instead they are embedded in tendons or muscle. The two sesamoid bones in the foot are each about the size of a kernel of corn (AAOS, n.d.).

The sesamoid bones have a couple of functions. They act like pulleys, giving the tendons a smooth surface to slide over. This increases the leverage of the small muscles that bend the big toe, which in turn increases their efficiency (AAOS, n.d.; Artioli et al., 2025). They also help with weight bearing and help to lift the bones of the big toe (AAOS, n.d.).

Like other bones, the sesamoids can break (fracture), either from a sudden injury, such as the big toe being bent backwards, or from repetitive stress (overuse). A fracture causes pain under the big toe on the ball of the foot, and you may find it hard or painful to bend and straighten the big toe (AAOS, n.d.).

Sesamoid Fracture Anatomy

Look at the bottom of your foot. Right where the ball of your foot meets the big toe is where these bones are located. The muscle/tendon that they are in is called the flexor hallucis brevis (Artioli et al., 2025). The two sesamoid bones each have different names. They are the tibial sesamoid, which is on the inner side, closer to the middle of the foot, and the fibular sesamoid, which is located toward the outer side.

In some people, the tibial sesamoid is in two parts. This is known as being bipartite. It is a normal variation rather than an injury, but on an X-ray the doctor needs to tell it apart from a fracture: the edges of a bipartite sesamoid are usually smooth, while the edges of a fracture are usually jagged (AAOS, n.d.). The tibial sesamoid is the one most often involved in sesamoid problems (Artioli et al., 2025).

Also some people have extra sesamoid bones which are just randomly present. Without an X-ray, it is impossible to accurately know.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat a Sesamoid Fracture

1. Non-Surgical Treatments

The vast majority of sesamoid fractures are treated without surgery (AAOS, n.d.). Once your medical team is happy for you to start, I can support your recovery with hands-on work, exercise, taping and help with padding and footwear. See the My Approach tab for how I work.

Pain relief: the American Academy of Orthopaedic Surgeons says pain relievers such as aspirin or ibuprofen may be recommended for a sesamoid fracture (AAOS, n.d.). (This medicine information comes from the American Academy of Orthopaedic Surgeons (OrthoInfo), not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
You may be advised to wear a J-shaped pad around the sesamoid to relieve pressure as the fracture heals. Cushioning pads or other orthotic devices are often helpful (AAOS, n.d.). I can help you work out what you need and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic.
Be patient: it may take several months for the discomfort to settle (AAOS, n.d.).

If these treatments do not improve the situation, your doctor may discuss surgery.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Stiff-soled shoe or fracture brace: a doctor may protect the foot with a stiff-soled shoe or a short-leg fracture brace, and may tape the big toe joint to limit its movement (AAOS, n.d.).
Cast: in some cases recovery involves a period in a cast without putting weight on the foot (AAOS, n.d.).
Surgery: for a fracture that is out of place or not healing, surgery may repair the bone or partly or totally remove the sesamoid, and, as with any operation, there are risks such as nerve injury (AAOS, n.d.; Artioli et al., 2025).

How I can help (see the My Approach tab)

Easing the areas that work overtime while your foot is protected
Taping the big toe once your team agrees, and showing you how
Foot and calf mobility, strength and a gradual return to activity

Tips

Good nutrition is always helpful in bone health. Make sure that you are getting an adequate amount of Vitamin D and calcium.
Whatever activities you are doing, always wear appropriate footwear… in the right size.
Sportsmen or women who are particularly heavy (hammer throwers, discus throwers, weightlifters) need to be careful with repetitive stomping of the ground.

Treatment

My Approach

A broken sesamoid needs protecting while it heals. Your medical team decides whether you need a stiff-soled shoe, brace or cast, and when you can put weight through the foot. I work inside those limits, and if your fracture was treated with surgery or stops your normal daily activities, I need your team's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

While It's Protected

Easing the other leg, hips and back, and your shoulders if you're on crutches
Gentle lymphatic drainage above the cast or brace for swelling, and keeping the ankle, knee and hip moving as your team allows

Once Your Team Allows More

Hands-on work for the calf and foot, off the ball of the foot, and scar work once any wound has healed
Taping the big toe if your team agrees, and showing you how to do it yourself
Gentle big toe and ankle movement, with joint mobilisation only once your team confirms the bone has healed
Foot, calf and balance work, building to running and, if you lift, heavier gym work, with care over the load through the ball of the foot

I'll help you work out what padding or orthotics you need, and point you to a chiropodist or podiatrist for custom orthotics. No heat goes over metal implants. If your toes go numb, pale or cold, a cast feels too tight, or pain or swelling suddenly gets worse, call 911 or go to the emergency room.

What to Expect

Typical Course

Typical course: While your foot is protected, visits are usually short and about weekly; once you can put weight through it, most people come once or twice a week, then weekly, then less often as they manage more on their own. Expect several months for the discomfort to settle, following your medical team's plan.

What I Focus On

Working Within Your Team's Limits

Compensation Relief

Swelling Control

Foot & Big Toe Mobility

Return to Activity

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Sesamoiditis and sesamoid fracture. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/sesamoiditis/ (Accessed: 7 October 2026).
Artioli, E. et al. (2025) 'Hallux sesamoid nonunion: a comprehensive systematic review of current evidence', Journal of Personalized Medicine, 15(8), p. 342. doi: 10.3390/jpm15080342

Massage therapy · Kitchener–WaterlooSesamoid Fracture

What It Is

Sesamoid Fracture Anatomy

Self-Care & Treatment

How to Treat a Sesamoid Fracture

1. Non-Surgical Treatments

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It's Protected

Once Your Team Allows More

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooSesamoid Fracture

What It Is

Sesamoid Fracture Anatomy

Self-Care & Treatment

How to Treat a Sesamoid Fracture

1. Non-Surgical Treatments

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While It's Protected

Once Your Team Allows More

Typical Course

References

Related Conditions

Extensor Tendon Rupture (Foot)

Achilles Tendinopathy

Extensor Hallucis Tendinopathy

Extensor Tendinopathy of the Foot

Book a session