musculoskeletal and connective tissue disorders
Sesamoiditis
Key Points
Dancers, joggers, and people who have high-arched feet, wear high heels, or have bunions can develop pain at the sesamoids beneath the head of the first metatarsal. Pain is worse when weight-bearing, particularly when wearing certain shoes. Diagnose based on clinical findings; exclude infection and gout with synovial fluid analysis when swelling is present and exclude suspected fracture with radiographs and sometimes MRI. Prescribe new, thick-soled shoes, offloading pads, and orthotics that decrease pressure on the sesamoids, or both. 