Date post: | 12-Jun-2015 |
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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