Sesamoiditis: Cause and Treatment

Post on 12-Jun-2015

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Pain on the undersurface of the great toe can limit function of the forefoot with walking, physical activity and sports. Early detection and treatment of sesamoiditis is essential to allow for healing and return of normal function. Fracture of the sesamoid bones can change normal mechanics of the foot and limit normal mechanics. This has serious consequences in sports and physical activity. http://bauerpt.com

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SesamoiditisAtanasia Barabas

Chapman University, DPT 2015Student Physical Therapist, Bauer PT

Anatomy ● 2 sesamoid bones in the tendon of the flexor hallucis

near the 1st MTP joint

● Function to:● to increase the mechanical advantage of the flexor

hallucis longus and brevis and increase plantarflexion strength at the 1st MTP joint

● Disperse forces to the medial forefoot

Pathology

● Inflammation of the FHL tendon surrounding the sesamoid bones due to overuse and repetitive stress● Causes can be structural, such as pes cavus foot type,

and/or mechanical in nature

Symptoms• Results in pain with weight bearing on the

forefoot

• Gradual onset of pain, worsened with increasing activity

• Aggravating factors include wearing high heels, jumping, running, stairs, and dancing

• Symptoms are alleviated with rest, ice, and non-weight bearing positions

Considerations for Treatment● First ray position and mobility

● Rear foot alignment and mobility

● Forefoot alignment

● Dorsiflexion range of motion

● Demand placed on the foot in ADLs or sports

● Current stage of healing

Clinical Findings● Common findings for individuals with this pathology

include:

● Loss of ROM at 1st MTP joint

● Decreased plantarflexion and dorsiflexion strength of great toe● Painful static test

● Tenderness to palpation on of the 1st MT head on the plantar aspect

● Decreased weight bearing ability due to pain

Differential Diagnosis● Bursitis

● Chrondromalacia

● Tenosynovitis of the FHL

● Sesamoid fracture

● MRI and X-ray can assist in diagnosis process

Treatment● EdURep Model

● Educate the patient about the nature of their pathology● Unload the tissue and allow tissue healing to occur● Reload the tissue to increase ROM and strength as

needed● Progress treatment to mimic functional activities and meet

the demand the patient puts on the tissue in their daily lives

Patient Education● Educate the patient about how they are placing excess

stress on the involved structures

● Teach patient how to move without stressing the sesamoids● Re-education for squatting, standing, walking

Unloading Phase● Decrease the stress on the sesamoids by dispersing

forces over the forefoot● Use metatarsal pads or soft arch support● Taping the 1st MTP joint into slight plantarflexion● Lower heel height

● Avoid activities that reproduce symptoms● No jumping● No excessive 1st MTP dorsiflexion

Reloading Phase● Once the patient is out of the inflammatory phase of

healing, progress to reloading the tissue to strengthen it and avoid re-injury

● Exercises focusing on FHL strength

● Stretching the 1st MTP joint to improve dorsiflexion

● Improving ankle ROM

Progress● Once the patient has sufficient strength and range,

progress to adding weight bearing and functional exercises that mimic the activities the patient has to get back to

● Squatting, jumping, running

References● Anwar R., Anjum S.N., Nicholl J.E. Sesamoids of the Foot.

Current Orthopaedics. 2005. 19(1)40-48.

● Beaman D.N., Nigo L.J. Hallucal Sesamoid Injury. Operative Techniques in Sports Medicine. 7(1)7-13.

● Image- http://sesamoiditis.net

● Image-http://www.eorthopod.com/content/sesamoid

● Image-http://www.performancefoot.com/ball-of-foot-pain-relief/47-dancers-sesamoid-pad-felt-1-4inch.html

● Image- http://www.protherapysupplies.com