Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 733.99 Other disorders of bone and cartilage ++ M89.30 Hypertrophy of bone, unspecified siteM89.8X9 Other specified disorders of bone, unspecified siteM94.8X9 Other specified disorders of cartilage, unspecified sites ++ 4E: Impaired joint mobility, motor function, muscle performance, and ROM associated with localized inflammation +++ Description1 ++ Inflammation and swelling of the peritendinous structures around the two sesamoid bones under the 1st metatarsal head, medial (tibial), and lateral (fibular) sesamoidIf caused by a sudden injury, may have a fracture of one or both sesamoidsWill alter mechanics during the push-off phase of gait +++ Essentials of Diagnosis ++ Diagnosis is usually made by clinical examination or x-rayCan be an independent diagnosis and not associated with a disease process +++ General Considerations ++ SwellingInflammation greatest on the plantar surface of the jointOften termed turf toe, but has a different tendinous structure injury2 +++ Demographics ++ Commonly seen inDancersPeople 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 timeThe elderly, due to age-related changes such as OA and osteoporosis +++ Signs and Symptoms ++ Early stageTenderness at the sesamoid bonesMild pain with walking, especially in thin soled shoesPain with running and jumpingMild swelling of sesamoids that subsides with rest/elevation/iceLate stageConstant pain may be presentPain with bending toes upPain with weight bearing activitySwelling of the soft tissue that does not subside with rest/elevationEventually, entire 1st metatarsophalangeal joint becomes swollenDecreased extension or dorsiflexion of the big toeJoint redness and painLimited motion of the MTP joint due to pain +++ Functional Implications ++ Pain with standingPain with ambulation at the toeAlteration 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 impactHereditary defectsHigh arches; rigid foot causing increased contact of the sesamoids with the groundPlantarflexed first rayIncreased pronationEnlarged sesamoids +++ Differential Diagnosis3 ++ Hallux valgusHallux rigidusRheumatoid arthritisGoutFractureTurf toeOsteochondritic lesion of the first metatarsal headOsteochondritis dissecansArthritisBursitisStress fractureChondromalaciaSynovitisHammer toeMetatarsalgiaMetatarsal stress fracture +++ Imaging ++ X-rayBone scanCT scanMRI ++ ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth