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Foot and ankle
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Chronic conditions are indistinguishable and range from stress fracture to avascular necrosis and sesamoiditis but are probably all the same phenomenon. Management includes offloading with orthotics and injections of steroids and, rarely, shaving/excison. Excision surgery carries a high risk.
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Pain and tenderness directly under the first metatarsal head, typically aggravated by walking or passive dorsiflexion of the great toe, may be due to sesamoiditis. This term is a misnomer: symptoms usually arise from irritation or inflammation of the peritendinous tissues around the sesamoids – more often the medial (tibial) sesamoid, which is subjected to most stress during weight-bearing on the ball of the foot.
The Ankle and Foot
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
Pain and tenderness directly under the first metatarsal head, typically aggravated by walking or passive dorsiflexion of the great toe, may be due to sesamoiditis. Symptoms usually arise from irritation or inflammation of the peritendinous tissues around the sesamoids.
Platelet rich plasma for hallux sesamoid injuries: a case series
Published in The Physician and Sportsmedicine, 2022
Hung M. Le, Andrea Stracciolini, Cynthia J. Stein, Bridget J. Quinn, Sarah S. Jackson
A 17-year-old female Irish step dancer and track & field sprinter presented for PRP treatment for bilateral tibial sesamoids, left greater than right. She developed bilateral tibial sesamoid pain 3 months ago in the setting of increasing her hours of Irish step dancing. MRI showed bilateral tibial sesamoiditis with fragmentation. CT showed healing changes of a stress fracture. She was treated with topical and oral NSAIDs, sesamoid pads, activity modification, physical therapy, bone stimulator, and short pneumatic boot without any relief. She underwent PRP to bilateral tibial sesamoids, left initially followed by the right side 6 weeks after. A two-stage approach was taken as it would have been difficult to immobilize both feet in pneumatic boots simultaneously. The left foot was pain free 4 weeks after PRP injection. The right foot was pain free 2 weeks following the procedure. 6 weeks after the second procedure, she was pain free with biking, walking, and weighted squats. She gradual progressed up to 1 mile run over the next 3 weeks, pain-free. Therefore, full recovery was obtained at 9 weeks following the final procedure, which was performed on the right foot.
Diagnosis and conservative management of great toe pathologies: a review
Published in Postgraduate Medicine, 2021
Nicholas A. Andrews, Jessyca Ray, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Sesamoiditis, inflammation of the peritendinous tissues including the sesamoid complex, can have both acute and chronic presentations as previously discussed. Chronic sesamoiditis is likely a consequence of repetitive training, especially jumping or running, or chronic use of high fashion footwear. Patients will describe the pain as developing gradually over time and worse with weight bearing. Signs of pronounced wear in the forefoot are commonly found upon inspection of footwear. Physical exam and imaging findings are as discussed in the acute sesamoiditis section above. A patient presenting with a long-standing history of pain and suspected sesamoid disorder would benefit from a 1 mm slice MRI of the great toe in order to differentiate different pathologies and establish a diagnosis. Conservative management relies on the reduction of aggravating activity, offloading techniques, and NSAIDs as described in the acute sesamoid disorder section.
Hallux sesamoid fractures in young athletes
Published in The Physician and Sportsmedicine, 2019
Cynthia J. Stein, Dai Sugimoto, Nathalie R. Slick, Corey J. Lanois, Bridget W. Dahlberg, Rebecca L. Zwicker, Lyle J. Micheli
In order to distinguish sesamoid fractures from other types of injury, a variety and often combinations of imaging including x-rays, MRIs, bone scans and CTs were used to make the diagnosis of a sesamoid fracture in our study population. MRI is generally the preferred study to distinguish between different causes of sesamoid pain [7,17]. At the present time, our protocol for pain at the first metatarsophalangeal (MTP) joint begins with anterior-posterior (AP), lateral and sesamoid view x-rays. If sesamoid fracture or injury remains in the differential, we obtain an MRI of the foot to help differentiate between sesamoiditis and sesamoid fracture. If symptoms persist despite treatment, our preferred imaging is then a CT scan to evaluate for the persistence of an unhealed fracture or the presence of avascular necrosis.