Hallux sesamoid bursae lie beneath the tibial (medial) and fibular (lateral) sesamoids of the first metatarsophalangeal joint, between the sesamoids and the plantar skin. They cushion the sesamoids from plantar surface pressure during standing and push-off. Inflammation of these bursae (sesamoid bursitis) is often associated with sesamoiditis and occurs from repetitive high-load plantar pressure.
Sesamoid bursitis produces a focal burning or aching pain directly beneath the first metatarsal head at the sesamoid level, worsened by barefoot walking on hard floors and by sports involving forefoot loading (dancing, distance running). It must be distinguished from sesamoid stress fracture by MRI, which demonstrates bursal fluid signal beneath the sesamoid without intrasesamoid signal change in pure bursitis. Management includes dancer's pads to offload the sesamoids, corticosteroid injection into the bursa, and activity modification. Resistant cases may require sesamoidectomy.
Repetitive plantar loading from barefoot running or minimalist footwear causes sesamoid bursitis with focal plantar pain at the first MTP sesamoid level; MRI distinguishes bursitis (fluid signal adjacent to intact sesamoid) from stress fracture (intrasesamoid signal change), with management using offloading pads and corticosteroid injection into the bursa.
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