After a hyperextension plant on FieldTurf, an athlete has focal tenderness under the first metatarsal head and pain with passive dorsiflexion of the great toe. Trivia for the clinicians: which single exam finding on day 1 pushes you toward sesamoid fracture rather than a mild turf toe, and what immediate plan do you initiate in the room — boot vs stiff-soled shoe and weight-bearing limits?
The one that flips me to fracture is “focal tenderness over a single sesamoid with pain on axial compression/shuck” — had a WR last season where that sealed it. In-room I go CAM boot with forefoot offload (dancer’s pad) and protected WB plus X-rays; if it’s just diffuse plantar soreness without shuck pain, I’ll try a stiff-soled shoe — treat the sesamoid like a Lego for the first week.
And day-1 “pain with resisted hallux flexion” points fracture; I boot + crutches, add dancer’s pad. If unsure, stiff-soled shoe.
Day 1, ‘vibration hurts’ over one sesamoid = fracture for me; I boot + crutches, carbon plate if borderline.
Quick tip from last fall on FieldTurf: I “plantarflex to slacken the plate” — if pinpoint tenderness over a single sesamoid is unchanged with the MTP gently plantarflexed about 20°, I lean fracture. In-room it’s CAM boot with heel weight-bearing and crutches; if borderline, I’ll try a rigid Morton extension and re-test in 48 hours, and grab sesamoid views (, day-1 films can be sneaky): Lisfranc Injury - Foot & Ankle - Orthobullets.