Sesamoiditis

• 733.99 Other disorders of bone and cartilage

• 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

• 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) 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

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 toe
• Metatarsalgia
• Metatarsal stress fracture

Imaging

• X-ray
• Bone scan
• CT scan
• MRI

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