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Sesamoiditis

Elizabeth E. Barton, MD, Vicki R. Nelson, MD, PhD and W. Franklin Sease, Jr., MD, FAAFP, FACSM Reviewed 06/2018
 


BASICS

DESCRIPTION

Painful inflammation (with minimal or no radiographic change) of one or both of the two sesamoid bones embedded in the flexor hallucis brevis tendon under the 1st metatarsophalangeal...

DIAGNOSIS

HISTORY

  • Acute or gradual onset of forefoot pain, which is exacerbated by direct pressure, weight bearing, and flexion/extension of the great toe

  • In contrast, if there is a history of trauma, w...

TREATMENT

GENERAL MEASURES

  • Decreased weight-bearing/activity modification

  • Off-loading of the MTP joint, which can be achieved with (3)[C]:

    • Rocker sole shoes

    • Soft-soled, low-heeled shoes

    • Orthotic devices

  • Ort...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Continue conservative management for 8 weeks.

  • Follow-up at 1, 4, and 8 weeks to assess pain and function.

Patient Monitoring

  • If pain does not improve within 2 to 4 w...

REFERENCES

1
Kadakia AR, Molloy A. Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int.  2011;32(8):834–839. [View Abstract on ...

ADDITIONAL READING

CODES

ICD10

  • M25.879 Other specified joint disorders, unspecified ankle and foot

  • M25.872 Other specified joint disorders, left ankle and foot

  • M25.871 Other specified joint disorders, right ankle and foot

ICD9

CLINICAL PEARLS

  • Sesamoiditis is most commonly seen with repetitive axial loading of 1st MTP.

  • Sesamoid fractures may not be apparent on initial radiographs. Repeat radiographs or MRI are indicated in pa...

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