Hallux Sesamoiditis - Radiological Diagnostics and Conservative Management

Abstract

Sesamoid bones play an essential role in first metatarsophalangeal (MTP) joint biomechanics, together with other articular surfaces, joint capsule, plantar fascia, ligaments and tendons. They are prone to different acute and chronic injuries, such as acute fracture, stress fractures, chondromalacia, avascular necrosis, bursitis degenerative changes, inflammation etc., all of which clinically manifest as a painful condition and are often diagnosed under a broad term called sesamoiditis. The mechanism of injury is most commonly associated with overuse of the anterior part of the sole of the foot accompanied by excessive dorsiflexion of the great toe. Sesamoiditis presents with pain and localized swelling in the projection of the tibial sesamoid bone, which is affected more frequently than the fibular one. Diagnostic radiology plays a key role in determination of etiology of the disease, as well as in planning of it’s treatment. Typical radiological examination includes weight-bearing dorsoplantar, lateral, oblique medial and oblique lateral radiographs of the foot, together with a direct axial radiograph of sesamoid bones. Computerized tomography is used for distinction of acute fractures and early stage of stress fractures from other pathological conditions. Magnetic resonance imaging allows differentiation between bony pathology and soft tissue conditions. Sesamoiditis management is primarily conservative and it depends on duration and severity of the condition. Orthotic insoles customized according to pedobarographic findings may be useful for solving biomechanical deformities that could have led to development of sesamoiditis. Specific pads placed under the first MTP joint in order to prevent the great toe from dorsiflexion proved to be a very effective conservative treatment option. Surgical treatment is considered if conservative methods fail to provide sufficient management of the