Sesamoiditis

Sesamoiditis is where there is inflammation and pain in sesamoid bones and surrounding soft tissues. Pain is felt under the 1st metatarsophalangeal joint. Young active people are most commonly affected. While sesamoiditis pain can come and go, it can cause great discomfort especially when walking.

Patient Signs and Symptoms

Isolated problem with plantar aspect of 1st metatarsophalangeal joint
Pain on weight bearing (especially in terminal stance)
Acute/not insidious onset
Pain on direct palpation of either sesamoid

Significant Findings

+/- History of Trauma
Associated foot deformity
+/- Swelling, effusion, dislocation, crepitus, erythema, warmth.
Pain on 1st metatarsophalageal joint range of motion/propulsion
Provocative manoeuvre
Pain with maximal dorsiflexion of the hallux
Pain/loss of strength on testing plantarflexion of the hallux

Associated Findings

Some foot types are more at risk of Sesamoid disorders

Cavus feet
Plantar-flexed/long first ray
Ankle equinus deformities
HAV deformities with deviated Sesamoids
Excessively pronated feet
Chondromalacia
Long flexor Tendinopathy
Hallux dorsiflexion is the most reproducible provocative manoeuvres as it involves stabilising the Sesamoid in its most distal position and then plantar-flexing whilst maintaining pressure on the Sesamoid

Imaging

Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.

Diagnosis made by clinical signs as typically indicates accurate diagnosis.

Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.

Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.

Common presentation on X-ray are: