9/24/2017

Sesamoiditis

Sesamoiditis

Sesamoiditis is an inflammatory condition of the sesamoid bones which are located on the plantar (bottom) aspect of the first metatarsal phalangeal joint (1st MPJ or big toe joint).

Treatment of Sesamoiditis

Conservative treatment of sesamoiditis consists of limiting activities and padding or 'off loading' of the joint. Off loading refers to taking the weight bearing load off of a particular area by use of a sleeping pad. In the case of sesamoiditis, the mat ought to be approximately 1/4" thick with a cut out for the bottom of the first MPJ. Should padding help, a prescription orthotic with a similar pad would be of use.

Surgical treatment of sesamoiditis usually consists of removal of the entire sesamoid bone. From time to time planing of the bone, or removing the bottom half of the bone may be a useful surgical procedure. Planing is employed less often than overall excision due to the fact that planing may weaken the sesamoid and lead to fractures of the sesamoid.

Removal of the tibial or fibular sesamoids does not typically result the normal function of the joint. If a patient has a family history of bunions or currently has a bunion, there will be a tendency to increase the rate that a bunion will form with isolated removal of the tibial sesamoid. By removing the tibial sesamoid, the pull of the FHB muscle will become slightly better via the remaining fibular sesamoid. As a result, this may speed up the formation of a bunion. If there is no history of bunions in the family, this may not even grow to be a factor in choosing to excise the tibial sesamoid.

Nomenclature:

First metatarsal phalangeal joint - the big toe shared. Often referred to as the 1st MPJ.

Itis - Used as a Suffix and Refers to Any Structure that is Swollen.

Plantarflex - to move down in the direction of the plantar surface (or floor).

  • Sesamoid is derived from Greek and refers to a sesame seed.
  • TheGreeks apparently related the shape of the sesamoid bone to a sesame seed.

Anatomy:

The two sesamoid bones are located on the bottom top of the first metatarsal phalangeal joint. The sesamoids are actually a working part of the First MPJ and articulate with the plantar top of the first metatarsal. The sesamoid bones tend to be an extension of the flexor hallucis brevis (FHB) muscle and give the FHB a greater range of motion and improved lever action at the level of the 1st MPJ.

  • Sesamoid bones are referred to by their location and are called the tibial sesamoid (medial) and also the fibular sesamoid (lateral).
  • Tibial and fibular make reference to the bones of the lower leg.
Sesamoid bones are most common in order to the first MPJ but may also be found at other tendon/joint areas where a tendon changes direction. Although they're discovered with much less frequency, other locations include the lower MPJ's and also even the metacarpal phalangeal joint (the thumb).

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Biomechanics:

The flexor hallucis brevis muscle (FHB) starts on the plantar surface of the calcaneus (heel bone). When the FHBfires, its' function is to plantarflex the great foot. The primary function of the FHB is to help in balance and assist the calf with the toe off portion of gait. As the FHB fires, the load generated by the body of the muscle is sent through the sesamoid to an file format of the FHB that attaches to the plantar part of the fantastic toe. The net result is that the great foot plantarflexes using the sesamoid bones to glide around the plantar surface of the 1st MPJ.

Symptoms:

The onset of sesamoiditis may be insidious or even abrupt. A good insidious onset would suggest a great inflammatory condition of the joint between the articular surface of the sesamoid and also the articular surface of the First metatarsal. An abrupt onset would suggest a fracture of the sesamoid. Regardless of onset, pain is typical specific to the bottom of the 1st MPJ. Occasionally the entire 1st MPJ may swell and become stiff. Pain is aggravated through long periods of standing, squatting and also the use of higher heeled shoes.

  • X-ray findings in cases of sesamoiditis usually show a heightened density of the affected sesamoid bone.
  • When viewing anAP x-ray, the appearance of the bone would light up better suggesting increased density of the bone consistent with inflammation.

Differential Diagnosis:

Arthritis.

Bunion

Fractured sesamoid.

Gout and Pseudogout

Hallux limitus and hallux rigidus.

Infection of the Joint (Septic Joint)

About the author:Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Medical professional. Oster can also be board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.

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