Small adventitial bursae develop between the two sesamoid bones (tibial and fibular sesamoids) and the overlying plantar skin and between the sesamoids and the first metatarsal head cartilage. These sesamoid bursae become inflamed in sesamoiditis — direct plantar forefoot loading producing inflammation at the sesamoid-skin and sesamoid-metatarsal interfaces.
Sesamoiditis produces plantar first MTP joint pain reproduced by direct pressure under the first metatarsal head and by passive dorsiflexion of the hallux. The tibial sesamoid is more commonly symptomatic than the fibular sesamoid. Radiograph identifies bipartite sesamoid (differentiated from fracture by rounded corticated margins) or frank fracture. MRI demonstrates bone marrow oedema in the sesamoid and adjacent bursal thickening. Conservative management with metatarsal offloading pads and orthotics is first-line; sesamoidectomy (tibial sesamoidectomy through a plantar approach preserving the FHB) is reserved for recalcitrant cases.
Direct plantar loading on the tibial sesamoid and its associated bursa produces plantar first MTP pain reproduced by digital pressure and passive hallux dorsiflexion; MRI demonstrates sesamoid bone marrow oedema and peribursitis; metatarsal offloading with a U-shaped cutout orthotic reduces direct sesamoid pressure and allows the bursa inflammation to resolve.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
