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 select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.