Sesamoiditis is a clinical term used generically to refer to painful conditions in and around the region of the hallucal sesamoids. Some expand the term to refer
Fig. 9. Close-up radiograph demonstrates a transverse fracture through the tuberosity of the fifth metatarsal; this is a Jones fracture.
to all painful conditions at the first MTP joint. Yet other authors have more specifically reserved the term to indicate chondromalacia of the sesamoids. Depending on its definition, this may account for up to 4% of overuse injuries of the foot  (Fig. 13).
There is a general consensus that the condition results from overload at the plantar aspect of the first MTP joint. This may be related to acute injury or chronic repetitive trauma. Predisposing risk factors include wearing high-heeled shoes, dancing, sports, and a cavus foot deformity with a rigidly plantar flexed first ray .
Patients may present with symptoms of sesamoiditis in the context of inflammatory arthritis, osteoarthritis, osteochondritis, or chondromalacia at the meta-tarso-sesamoid articulation. Alternatively, there may be stress fracture or osteonecrosis of the sesamoid  (Fig. 14).
Imaging must include standard weight-bearing AP and lateral radiographs to assess congenital forefoot deformities and possibly identify arthritic changes. A sesamoid view is essentially an oblique coronally oriented radiograph, obtained tangential to the metatarso-sesamoid joint, which permits direct visualization of the joint space and articular surfaces, and eliminates osseous superimposition. Over time, radiographs may reveal fragmentation and sclerosis of the sesamoids. Nuclear bone scintigraphy is sensitive for demonstration of pathologic radiotracer uptake in the sesamoid region but does not effectively narrow the differential diagnosis. As compared with conventional radiography, CT affords
more sensitive and specific detection of fracture, and may permit visualization of periostitis, callus formation, articular irregularity, and pseudocyst formation, as well as subarticular or articular collapse of osteonecrosis. MRI may be reserved for cases in which CT is unrevealing, as in stress-related marrow edema, occult fracture, early osteonecrosis, or chondromalacia . In addition to elucidating radiographically occult osseous changes, MRI delineates reactive soft tissue changes, including synovitis, tendonitis, and bursitis.
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