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213: SESAMOIDITIS

Christina L. Pettie, MHA, PT; Eric Shamus, PhD, DPT, PT, CSCS

ICD-9-CM CODE

  • 733.99 Other disorders of bone and cartilage

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERN

  • 4E: Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation

PATIENT PRESENTATION

Patient is a 56-year-old plumber. Two weeks ago he was working in a tight area under the sink and had his ankle dorsiflexed with all of the weight on his forefoot. The toes were all into extension. When he stood up he had pain under his big toe from what he described as an over stretching. He tried to put some ice on his foot. He presents with decreased motion at the first metatarsophalangeal (MTP) joint with swelling. He is having difficulty pushing off on the foot when trying to go up the ladder. Upon palpation he is point tenderness at the flexor hallicus longus and both sesamoids.

KEY FEATURES

Description1

  • Inflammatory condition of the periosteum of the sesamoid bone

  • Inflammation and swelling of the peritendinous structures around the two sesamoid bones under the first 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

Essentials of Diagnosis

  • Diagnosis is usually made by clinical examination or X-ray

  • Can be an independent diagnosis and not associated with a disease process

General Considerations

  • Swelling

  • Inflammation greatest on the plantar surface of the joint

  • Often termed turf toe, but has a different tendinous structure injury2

Demographics

  • 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 osteoarthritis (OA) and osteoporosis

FIGURE 213-1

Resisted great toe extension. (From Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 3rd ed. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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 first MTP ...

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