pathology: sesamoiditis

yogabook / pathology / sesamoiditis

Definition

Sesamoiditis is a usually chronic inflammation of a sesamoid bone or its surrounding tissues. By far the most common occurrence of sesamoiditis is on the sesamoid bones of the hallux or the 1st metatarsal bone.

Cause

  1. mechanical overload
  2. traumatic

Predisposing

  1. Footwear inappropriate for the walking or running route in terms of type or length, such as boots or high heels
  2. foot deformities such as hollow foot or lower foot/flat foot
  3. Lack of foot muscles or fat pads
  4. High body weight and training with additional weight
  5. forefoot running
  6. Excessive size of the sesamoid bones
  7. Impact-type sports, including sports with iterated jumps such as volleyball but also highly repetitive sports with impact-type ground contact such as running (jogging, running)

Symptoms

  1. Small-area localised strain pain developing over time, between dull and sharp
  2. In the case of the sesamoid bones of the hallux:
    • affecting one or both sesamoid legs (medial, lateral)
    • painful restriction of movement of the metatarsophalangeal joint in the direction of plantar flexion and dorsiflexion
  3. Rather moderate onset of pain with increasing intensity during exercise
  4. pressure soreness of the sesamoid bones
  5. Possibly signs of inflammation, small area of swelling

Diagnosis

  1. The diagnosis is usually made clinically, but can be complicated by concomitant bursitis, tendinosis or tendosynovitis
  2. Imaging: X-ray, MRI, CT, to rule out fracture, dislocation and arthrosis. The MRI differentiates better between fractures and multipartite sesamoid bones
  3. Tests and signs:
    sesamoids of the hallux: Passive Axial Compression Test

Complications

Therapy

  1. Stop stress, cooling
  2. Insoles that are gentle on the area
  3. If necessary, NSAIDs against the inflammation
  4. Cortisone injection into the MTP1 if necessary
  5. If conservative therapy fails (after 4-6 months), sesamoidectomy (CAVE: changes biomechanics!). The dislocation may indicate surgical intervention.

DD

  1. Tendosynovitis
  2. Fractures that result in inflammation
  3. Bursitis
  4. Tendinosis
  5. gout
  6. Localised infections, especially of the joint (if suspected: synovial fluid analysis)