From the Research
The best management for a moderate grade sesamoidphalangeal ligament tear typically involves a conservative approach initially, with rest, ice, compression, and elevation (RICE protocol) and limited weight-bearing for 4-6 weeks, as supported by the most recent study 1 from 2025. This approach is crucial in reducing pain and swelling, and preventing further injury. The use of a walking boot, stiff-soled shoe, or taping to immobilize the joint can help alleviate symptoms. Pain management can include NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as mentioned in various studies 2, 3. Physical therapy should begin after the acute phase, focusing on gentle range of motion exercises, progressive strengthening of the intrinsic foot muscles, and proprioceptive training. Custom orthotic inserts with a cutout beneath the sesamoid can help redistribute pressure during the healing process, as suggested by study 3 from 1991. Gradual return to activities should occur over 8-12 weeks, with modifications to footwear including shoes with adequate cushioning and a wider toe box. Some key points to consider in the management of sesamoidphalangeal ligament tears include:
- The importance of early diagnosis and treatment to prevent chronic pain and instability
- The use of imaging techniques, such as MRI, to confirm the diagnosis and guide treatment, as discussed in study 1 from 2025
- The need for a multidisciplinary approach, including physical therapy and orthotic management, to ensure optimal outcomes
- The rare need for surgical intervention, unless conservative treatment fails after 3-6 months, as mentioned in study 3 from 1991. Overall, a conservative approach with careful monitoring and gradual progression of activities can help ensure the best possible outcome for patients with moderate grade sesamoidphalangeal ligament tears.