My 13-year-old daughter is a figure skater who competes at the local and state levels. Recently, she fell when landing a jump and broke her ankle. The doctor called it a “stress fracture.” How is this different from a regular fracture?

A stress fracture is sometimes called a “stress reaction” or “fatigue fracture.” This is damage to the outer layer of bone from repeated stress. It is different from a complete fracture because the break doesn’t go completely through the thin layer of bone. A stress fracture is considered “microtrauma” or “microdamage.”


These types of fractures are most common in runners and soldiers in training, but dancers, gymnasts, and figure skaters are also at risk. These fractures develop because of compressive forces on the bone from landing on one leg after jumping. They can also occur as a result of the repeated action of muscles pulling on the bone.

Since the arthritis in my foot has gotten worse, it seems like I’m walking a lot more flat-footed. Is this my imagination, or should I seek treatment for it?

Joints stay healthiest when they have good alignment. Problems can happen when the alignment begins to change because of the effects of arthritis. If nothing is done about it, the change in position can eventually cause the joint to become deformed. The added strain of bearing weight onto the foot can cause an arthritic foot to roll in on the inside edge, giving the foot a flattened appearance. The altered alignment can cause pain because the joints of the foot and ankle get stretched and strained. Your doctor may prescribe a special shoe insert, called an orthotic, to help support your foot in its best alignment. This type of treatment is sometimes needed to help ease joint pain and to prevent additional injury and deformity.

I have heel spur syndrome. I’ve been doing physical therapy for two months, but the pain hasn’t gone away. What other treatments can I try?

A small percentage of patients with heel spurs don’t get relief, even with physical therapy treatments. Doctors may prescribe additional medication, heel cushions, or possibly an injection of steroid medicine into the sore heel. If patients still don’t get relief, surgery to remove the spur may be an option.


Doctors in Cuba recently reported on a less-invasive technique to remove heel spurs. These doctors use an endoscope–a small camera-like device–to find and remove bone spurs without making big incisions. Though this technique was only tried on 30 patients, the results were impressive. Within three months of surgery, all of the patients reported good or excellent results. One year after surgery, all but five of the patients were pain-free. (The five patients who did feel pain had been involved in sports and got relief after receiving physical therapy treatments.)


Patients in this study weren’t operated on until they had tried other conservative treatments for five months, including two months of physical therapy. If your pain persists over the next few months, you may want to talk with your doctor about available options to help manage your symptoms.

I am a collegiate high jumper. I somehow ended up with a stress fracture in the small bones under my big toe, the sesamoids. The pain has been going on for months. Now my doctor wants to do surgery to graft new bone where the sesamoids didn’t heal. I’ve been told I won’t be able to compete for at least four months after the surgery, which means I’ll have to miss the upcoming track season. Why can’t the doctor just go in and take the bones out so I can get back to my sport?

Your performance as a high jumper would be significantly worse if both the sesamoid bones were taken out. The sesamoid bones may be small, but they play a vital role in the way the foot and big toe work. The sesamoids are embedded in the soft tissues under the main joint of the big toe. The short flexor muscle of the big toe passes over the “bump” formed by these two bones. This bump acts as a fulcrum point to give leverage for the toe flexor muscle. The toe flexor muscle wouldn’t work as well if the sesamoid bones were taken out, and your big toe might start to slant outward and bend up like a claw. Rather than taking the bone out, your doctor can keep the fulcrum point intact with a bone graft.

I have heel spurs. What are my treatment options?

For starters, heel spur syndrome–the condition brought on by bony growths on the heel–usually requires that you rest the sore foot. Physical therapy is also a good option. A physical therapist uses heat and cold, heel cushions, and special exercises to get you back on your feet. Your doctor may also prescribe anti-inflammatory drugs to ease your recovery. When pain still won’t go away, your doctor may suggest injecting steroid medicine into the sore area. 


A small percentage of patients don’t get relief after trying these treatments for several months. If you’re one of them, you may want to find out about surgery to remove the spur. So far, patients have had good results from a new endoscopic procedure, which uses a small camera-like device to find and remove bone spurs. This procedure may be an option for you further down the road.

I have heel spur syndrome. How long should I expect this pain to last?

Heel spur syndrome–a condition brought on by bony growths on the heel–usually runs its course within 12 to 18 months. But you needn’t be in pain for that long. You can speed your recovery by resting and icing your sore foot, and by having physical therapy. Physical therapy, along with medication, heel cushions, and possibly even steroid injections in the sore heel, usually helps patients feel better within a few months. If these treatments aren’t working for you, your doctor may suggest surgery as an option to remove the spur. Talk with your doctor to learn about other ways to help manage your symptoms.

Can high arches in my feet cause arthritis in my big toes?

Yes. Having high arches suggests that the foot may not flatten (pronate) as much as normal when you walk. This means the foot is more rigid. A rigid foot puts extra pressure on nearby joints and soft tissues.

The main joint of the big toe doesn’t move as much in people with high arches. This puts an extra strain on the toe. It can also put added stress on two small bones under the main joint of the big toe. These bones are called the sesamoids.

So high arches can lead to arthritis in the big toe joint. And arthritis in the big toe joint can in turn cause arthritis where the sesamoids join the big toe.

My doctor diagnosed the pain under my big toe as sesamoiditis. She said it has something with two small bones under the joint. What is sesamoiditis? Will I need surgery?

There are two pea-sized bones in the soft tissues under the main joint of the big toe. These tiny bones are called the sesamoids. The condition called sesamoiditis develops when the soft tissues around these bones become inflamed.


Doctors usually don’t recommend surgery for sesamoiditis, at least not right away. They usually recommend anti-inflammatory mediations, rest, and ice. Special shoes or padding inside your regular shoe can keep the big toe from bending as you walk. This gives your painful toe a chance to heal. Your doctor may suggest a steroid injection if your pain continues. Doctors usually recommend surgery only if the problem is severe or doesn’t get better with other kinds of treatment.

Last month I jumped off the tailgate of my truck and landed hard on the ball of my right foot. Now it hurts whenever I’m on my feet for a long time, or when my big toe gets bent upward. Could I have broken my big toe?

It’s more likely that you hurt the two small bones under the main joint of the big toe, the sesamoids. The impact may have caused inflammation in the soft tissues around the sesamoids. This condition is called sesamoiditis. You should tell your doctor about your injury. It is possible that your jump caused a fracture in one or both of the sesamoid bones. 

I am a professional dancer. My doctor said the pain under my big toe is from sesamoiditis. The pain is getting worse as time goes on. Is dancing causing my toe pain? If it is, what can I do so I can keep up with my schedule?

The sesamoids are two small bones underneath the big toe joint. When the soft tissues around them become inflamed, the condition is called sesamoiditis. Sesamoid problems often start with repeated motions of the foot and big toe joint. Athletes, especially dancers, are prone to this kind of injury. Your problem could have started from doing similar dance steps over and over again.


Treatment should include resting your sore joint. You need to give your toe a chance to heal. Until the pain and inflammation are under control, you will find it hard to regain your mobility and strength. Heavy use of your toe will keep the area inflamed and painful. It would be best if you lessened your work demands for a while, until the sesamoid problem resolves.


I started running about two months ago. When I added more miles, I started noticing pain in the bottom of my big toe. I’ve tried resting it for days at a time, but the pain just keeps coming back when I start running again. What is causing this pain? Should I talk to my doctor about it?

There are two small bones, called the sesamoids, under the main joint of the big toe. Inflammation of the tissues around the sesamoids is called sesamoiditis. Sesamoid problems are common among runners and other athletes who do similar movements of the big toe.


It is concerning that your toe pain got worse after adding more miles, and that you still have pain even after rest periods. You may have developed a stress fracture in one or both sesamoids. You should see your doctor.


By the end of the work day, I have severe pain in the ball under my big toe. When I take my shoes off, my foot feels much better. The shoes are a good brand, with good arch support. Should I get a different type of shoe?

You may have a problem with your shoe, but it may not be the style or brand. It is quite possible your shoes are too small for your foot. When you shop for shoes, be aware that different types of shoes and different brands often differ in size and width. A size nine in one shoe may be different than a size nine of another make and model. Your shoe may be too tight in the forefoot. This squeezes the soft tissues around the big toe. A shoe with a larger toe box may help ease the pressure on the ball of your big toe.

I was told I have sesamoiditis in my left big toe. It especially hurts when I’m walking and my left foot pushes off for the next step. How I can keep the pain to a minimum?

The sesamoids are two tiny bones underneath your big toe joint. Sesamoiditis is a condition where the tissues around the sesamoids become inflamed. Problems with sesamoiditis may not go away if repeated movements in the big toe, such as bending the toe when you walk, keep the painful area inflamed. Rest your toe as much as possible, and shorten your stride when you walk.


If your problem doesn’t get better after a period of resting and protecting the joint, talk to your health care provider. He or she can suggest ways to keep the big toe from bending when you walk. Special padding, shoe inserts, and special shoes can help protect your toe while you walk and allow it to heal.


How can doctors tell if the sesamoid bone in my big toe has a fracture?

The sesamoids are two tiny bones underneath the joint of the big toe. An X-ray may show a space within the sesamoid bone. If the line looks jagged, it is probably a fracture.


In some cases, the line is smooth. This suggests a condition called bipartite sesamoid. About 10% of people have this condition. When people have a bipartite sesamoid on one toe, there’s a 25% chance that they’ll also have one on the other toe. If a doctor suspects a bipartite sesamoid, he or she may check the other toe to try and confirm the diagnosis. It would be unlikely to have a sesamoid fracture in both toes, so another line on the second X-ray would definitely suggest a bipartite sesamoid.


If the diagnosis still isn’t clear, the doctor may order a bone scan. A bone scan involves injecting a radioactive chemical, called a “tracer,” into your blood. When the tracer is circulating in your bloodstream, a technician takes pictures using special imaging equipment that detects the radiation. Accumulations of the tracer show up in fractures.