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  • 733.99 Other disorders of bone and cartilage

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  • M89.30 Hypertrophy of bone, unspecified site
  • M89.8X9 Other specified disorders of bone, unspecified site
  • M94.8X9 Other specified disorders of cartilage, unspecified sites

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Description1

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  • Inflammation and swelling of the peritendinous structures around the two sesamoid bones under the 1st metatarsal head, medial (tibial), and lateral (fibular) sesamoid
  • If caused by a sudden injury, may have a fracture of one or both sesamoids
  • Will alter mechanics during the push-off phase of gait

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Essentials of Diagnosis

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  • Diagnosis is usually made by clinical examination or x-ray
  • Can be an independent diagnosis and not associated with a disease process

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General Considerations

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  • Swelling
  • Inflammation greatest on the plantar surface of the joint
  • Often termed turf toe, but has a different tendinous structure injury2

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Demographics

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  • Commonly seen in
    • Dancers
    • People who squat for long periods of time (i.e., baseball players)
    • People who often run/jump on the balls of their feet (i.e., sprinters)
    • Women who wear high heels while standing or walking for long periods of time
    • The elderly, due to age-related changes such as OA and osteoporosis

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Signs and Symptoms

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  • Early stage
    • Tenderness at the sesamoid bones
    • Mild pain with walking, especially in thin soled shoes
    • Pain with running and jumping
    • Mild swelling of sesamoids that subsides with rest/elevation/ice
  • Late stage
    • Constant pain may be present
    • Pain with bending toes up
    • Pain with weight bearing activity
    • Swelling of the soft tissue that does not subside with rest/elevation
    • Eventually, entire 1st metatarsophalangeal joint becomes swollen
  • Decreased extension or dorsiflexion of the big toe
  • Joint redness and pain
  • Limited motion of the MTP joint due to pain

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Functional Implications

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  • Pain with standing
  • Pain with ambulation at the toe
  • Alteration of gait pattern and mechanical issues of the forefoot, can increase supination and external rotation of the foot for clearance; also forefoot abduction, lateral whip

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Possible Contributing Causes

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  • Age related changes (i.e., osteoarthritis, which may cause bone spurs, or osteoporosis, which may cause fractures)
  • Direct injury (i.e., stepping on something hard)
  • Microtrauma: overuse injury/repetitive stress and high impact
  • Hereditary defects
    • High arches; rigid foot causing increased contact of the sesamoids with the ground
    • Plantarflexed first ray
    • Increased pronation
    • Enlarged sesamoids

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Differential Diagnosis3

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  • Hallux valgus
  • Hallux rigidus
  • Rheumatoid arthritis
  • Gout
  • Fracture
  • Turf toe
  • Osteochondritic lesion of the first metatarsal head
  • Osteochondritis dissecans
  • Arthritis
  • Bursitis
  • Stress fracture
  • Chondromalacia
  • Synovitis
  • Hammer toe
  • Metatarsalgia
  • Metatarsal stress fracture

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Imaging

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  • Edema
  • Fracture4

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