musculoskeletal and connective tissue disorders
Sesamoiditis
Diagnosis of Sesamoiditis
Clinical evaluation Arthrocentesis if there is circumferential joint swelling Imaging if fracture, osteoarthritis, or displacement is suspected With the foot and first (great) toe dorsiflexed, the examiner inspects the metatarsal head and palpates each sesamoid. Tenderness is localized to a sesamoid, usually the tibial sesamoid. Hyperkeratotic tissue may indicate that a wart or discrete callus is causing pain. If inflammation causes circumferential swelling around the first metatarsophalangeal joint, arthrocentesis is usually indicated to exclude Gout and If fracture, osteoarthritis, or displacement is suspected, x-rays are taken. Sesamoids separated by cartilage or fibrous tissue (bipartite sesamoids) may appear fractured on radiographs. If radiographs are equivocal, MRI is indicated for diagnosis. 