A fracture of one or both sesamoid bones produces many of the same symptoms as sesamoiditis: pain in the ball of the foot and first metatarsophalangeal joint, swelling, and limited plantarflexion/dorsiflexion. In sesamoiditis, chronic abuse causes a gradual onset of pain. In a sesamoid fracture, the onset of pain usually results from traumatic injury to the ball of the foot. This commonly involves a fall from height, in which the patient lands heavily on the feet, fracturing one or both sesamoid bones.
A fractured sesamoid produces substantial swelling throughout the forefoot and a deep, tender bruise in the area of the big toe's metatarsophalangeal joint. X-rays are often necessary to confirm a sesamoid fracture. Occasionally, however, x-rays are inconclusive because a small percentage of people have bipartite sesamoid bones. Instead of one medial and one lateral sesamoid bone under each first metatarsal head, they have sesamoid bones that are divided into two pieces.
Because these bones are so small, the radiologist may be unable to distinguish a fractured sesamoid from a bipartite sesamoid, or a fractured bipartite sesamoid from a whole one. In rare cases, a bone scan may be necessary to confirm a fracture.