Abstract
Sesamoiditis is one of the most common pain syndromes that affects the forefoot. It is characterized by tenderness and pain over the metatarsal heads. Although the first sesamoid bone of the first metatarsal head is affected most commonly, the sesamoid bones of the second and fifth metatarsal heads also are subject to the development of sesamoiditis. The patient often feels that he or she is walking with a stone in his or her shoe. The pain of sesamoiditis worsens with prolonged standing or walking for long distances and is exacerbated by improperly fitting or padded shoes. Sesamoiditis is most often associated with pushing-off injuries during football or repetitive microtrauma from running or dancing. The sesamoid bones are small, rounded structures that are embedded in the flexor tendons of the foot, usually in close proximity to the joints. Sesamoid bones of the first metatarsal occur in almost all patients, with sesamoid bones being present in the flexor tendons of the second and fifth metatarsals in a significant number of patients. These sesamoid bones decrease friction and pressure of the flexor tendon as it passes in proximity to a joint.
Keywords
sesamoiditis, foot pain, metatarsalgia, intermetatarsal bursitis, tendinitis, plantar fasciitis, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection
ICD-10 CODE M25.871
Keywords
sesamoiditis, foot pain, metatarsalgia, intermetatarsal bursitis, tendinitis, plantar fasciitis, magnetic resonance imaging, diagnostic sonography, ultrasound guided injection
ICD-10 CODE M25.871
The Clinical Syndrome
Sesamoiditis is one of the most common pain syndromes that affects the forefoot. It is characterized by tenderness and pain over the metatarsal heads. Although the first sesamoid bone of the first metatarsal head is affected most commonly, the sesamoid bones of the second and fifth metatarsal heads also are subject to the development of sesamoiditis. The patient often feels that he or she is walking with a stone in his or her shoe ( Fig. 134.1 ). The pain of sesamoiditis worsens with prolonged standing or walking for long distances and is exacerbated by improperly fitting or padded shoes. Sesamoiditis is most often associated with pushing-off injuries during football or repetitive microtrauma from running or dancing. The sesamoid bones are small, rounded structures that are embedded in the flexor tendons of the foot, usually in close proximity to the joints. Sesamoid bones of the first metatarsal occur in almost all patients, with sesamoid bones being present in the flexor tendons of the second and fifth metatarsals in a significant number of patients. These sesamoid bones decrease friction and pressure of the flexor tendon as it passes in proximity to a joint.
Signs and Symptoms
The patient suffering from sesamoiditis will experience pain with any weight bearing that worsens with prolonged standing and walking. Stair climbing may become increasingly difficult as the inflammation increases. Wearing high heels, poorly fitting, and/or inadequately padded shoes will exacerbate the patient’s functional disability and pain. Often, the patient with sesamoiditis will experience the sensation of walking on a stone in his or her shoe.
On physical examination, pain can be reproduced by pressure on the sesamoid bone. In contradistinction to metatarsalgia, in which the tender area remains over the metatarsal heads, with sesamoiditis the tender area moves with the flexor tendon when the patient actively flexes his or her toe. A callus overlying the affected sesamoid bone may be present ( Fig. 134.2 ). The patient with sesamoiditis often exhibits an antalgic gait in an effort to reduce weight bearing during walking. With acute trauma to the sesamoid bone, ecchymosis over the plantar surface of the foot may be present.
Testing
Plain radiographs, magnetic resonance, and ultrasound imaging are indicated in all patients who present with pain thought to be caused by sesamoiditis, to rule out occult bony disorders and tumor ( Figs. 134.3, 134.4, and 134.5 ). Radionuclide bone scanning may rule out stress fractures not visible on plain radiographs ( Fig. 134.6 ). Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, comprehensive metabolic profile, prostate-specific antigen level, erythrocyte sedimentation rate, and antinuclear antibody testing. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
