When should I see a podiatrist?

You should see a podiatrist for any persistent foot or ankle pain lasting more than a few days, difficulty walking, numbness or tingling, wounds that won't heal, changes in skin color or temperature, or structural deformities. Dr. Tom Biernacki, DPM is a board-certified podiatrist serving SE Michigan with same-day appointments available. Call 810-206-1402.

Does Dr. Biernacki accept insurance?

Balance Foot & Ankle accepts most major insurance plans including Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Medicare, and many others. Contact our office at 810-206-1402 to verify your specific coverage. We also offer affordable self-pay options.

What should I expect at my first podiatry appointment?

Your first visit includes a comprehensive evaluation with Dr. Biernacki including medical history review, physical examination, biomechanical assessment, and any necessary diagnostic imaging (X-rays are available in-office). You'll receive a diagnosis, treatment plan, and same-day treatment when possible. Most initial visits take approximately 30-45 minutes.

What is avascular necrosis of the sesamoid?

Avascular necrosis (AVN) occurs when blood supply to the sesamoid bone is disrupted, causing the bone to die and fragment. It causes persistent pain under the big toe joint that doesn't respond to typical treatments. MRI shows characteristic marrow signal changes. Treatment often requires surgical removal of the affected sesamoid.

How do you tell a bipartite sesamoid from a fracture?

Bipartite sesamoids (a normal variant in 10-30% of people) have smooth, rounded edges and are often bilateral. Fractures have irregular, jagged edges. X-rays of both feet can help compare — if both sides show the same pattern, bipartite is likely. MRI or bone scan confirms acute injury with bone edema.

What happens after sesamoid removal surgery?

Sesamoidectomy (removing one sesamoid) has good outcomes with 85-90% pain relief. Removing the tibial (inner) sesamoid carries a small risk of hallux valgus drift. Recovery involves 4-6 weeks in a surgical shoe with forefoot offloading. Custom orthotics help redistribute pressure long-term.

First MTP Sesamoid Injuries: Fracture & Sesamoiditis

Name: First MTP Sesamoid Injuries: Fracture & Sesamoiditis
Creator: Dr. Tom Biernacki, DPM
Published: 2026-03-22T08:58:34-04:00

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.

The two sesamoid bones of the first metatarsophalangeal joint — the medial (tibial) and lateral (fibular) sesamoids — are embedded within the flexor hallucis brevis tendons and bear up to three times body weight during push-off. Sesamoid injuries produce plantar first MTP pain that is frequently attributed to plantar fasciitis or metatarsalgia and treated suboptimally for months before the sesamoid is identified as the pain generator.

Treatment at Balance Foot & Ankle: Foot Emergency Guide →

Sesamoid Fracture vs. Bipartite Sesamoid

The medial sesamoid is bipartite (naturally divided into two ossicles) in 10–30% of normal feet — radiographically indistinguishable from a fracture without comparison views or MRI. The key distinguishing features: a fracture produces jagged, irregular margins; a bipartite sesamoid has smooth, corticated borders and the same finding is typically present on the contralateral foot (bilateral in 85% of bipartite cases). MRI is the definitive study: acute fracture shows bone marrow edema and cortical disruption; bipartite sesamoid has fibrocartilaginous union without edema; avascular necrosis (AVN) shows decreased T1 signal with preserved or enhanced T2 signal reflecting marrow ischemia.

Management by Diagnosis

Sesamoiditis (stress response without fracture): reduced weight-bearing on the sesamoid with a sesamoid dancer pad (a U-shaped cut-out pad placed proximal to the sesamoid, transferring load to the metatarsal shaft rather than the sesamoid); custom orthotics with sesamoid relief; activity modification for 6–12 weeks. Sesamoid fracture: non-weight-bearing cast for 4–6 weeks for acute non-displaced fractures; surgical excision of the fractured sesamoid fragment for displaced fractures or non-union after 3 months of conservative management. AVN of the sesamoid: excision of the avascular sesamoid when conservative management fails; sesamoidectomy requires careful closure of the flexor hallucis brevis tendon to prevent hallux cock-up deformity from loss of flexion force. Dr. Biernacki at Balance Foot & Ankle evaluates plantar first MTP pain with weight-bearing X-ray and MRI when sesamoid pathology is suspected. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

📧 Get Dr. Tom’s Free Lab Test Guide

Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.

Download Your Free Guide →

📍 Located in Michigan?

Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.

Book Now →
(810) 206-1402

When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

Pain that persists for more than 2 weeks despite rest
Swelling, redness, or warmth that isn’t improving
Numbness, tingling, or burning in the feet
A wound or sore that is not healing within 2 weeks
Any foot concern if you have diabetes or poor circulation
Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

Related Conditions & Resources

View All Treatments →

Ready to Get Relief? We’re Here to Help.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

📅 Book Online
📞 (810) 206-1402

Sesamoid Fracture & Avascular Necrosis Treatment in Michigan

Sesamoid injuries under the big toe — from stress fractures to avascular necrosis — cause disabling forefoot pain. Our podiatrists provide expert diagnosis differentiating bipartite sesamoids from true fractures, with treatment options from orthotics to surgical sesamoidectomy.

Explore Forefoot Pain Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

Richardson EG. Hallucal sesamoid pain: causes and surgical treatment. J Am Acad Orthop Surg. 1999;7(4):270-278.
Cohen BE. Hallux sesamoid disorders. Foot Ankle Clin. 2009;14(1):91-104.
Bichara DA, Henn RF, Theodore GH. Sesamoiditis of the hallux. Foot Ankle Clin. 2014;19(1):29-40.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.

Related reading: Plantar Fasciitis Secrets — our complete heel pain guide: what works and what to avoid.

Medical References

Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
Plantar Fasciitis (APMA)
Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
Heel Pain (APMA)

This article has been reviewed for medical accuracy by Dr. Tom Biernacki, DPM. References are provided for informational purposes.