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ICD-9-CM Code

  • 733.99 Other disorders of bone and cartilage

ICD-10-CM Code

  • 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

Key Features

Description1

  • 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

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 OA and osteoporosis

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 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

Functional Implications

  • 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

Possible Contributing Causes

  • 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

Differential Diagnosis3

  • 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 ...

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