From the Guidelines
Sesamoiditis is diagnosed through a combination of clinical evaluation and imaging studies, with ultrasound being a useful tool in diagnosing tears of the sesamoid phalangeal ligament and visualizing soft tissue inflammation around the sesamoid bones 1. When diagnosing sesamoiditis, a healthcare provider will first take a detailed medical history and perform a physical examination, looking for tenderness at the base of the big toe, pain with movement, and swelling. They will typically ask about activities that worsen symptoms and may test range of motion.
Imaging Studies
- X-rays are commonly ordered to visualize the sesamoid bones and check for fractures or other abnormalities, though sesamoiditis itself may not always be visible on X-rays.
- In some cases, additional imaging such as MRI, CT scan, or bone scans may be necessary to confirm the diagnosis, especially if X-rays are inconclusive.
- CT scans can be useful to confirm suspected sesamoid stress fractures on radiographs and to distinguish between a stress fracture and a bipartite sesamoid with more precision than conventional radiography 1.
- Ultrasound has been shown to be useful in diagnosing tears of the sesamoid phalangeal ligament in the setting of turf toe and can demonstrate Morton’s neuroma and fluid-filled intermetatarsal bursae 1. The diagnosis is often confirmed when other potential causes of forefoot pain, such as stress fractures, arthritis, or gout, have been ruled out through this systematic approach.
Diagnostic Approach
- A systematic approach to diagnosis, including clinical evaluation and imaging studies, is necessary to confirm sesamoiditis.
- The choice of imaging study depends on the specific clinical presentation and the need to rule out other potential causes of forefoot pain.
- Ultrasound and CT scans can be useful tools in the diagnosis of sesamoiditis, particularly in cases where X-rays are inconclusive 1.
From the Research
Diagnosis of Sesamoiditis
- Sesamoiditis is diagnosed through a combination of clinical evaluation and imaging studies, as symptoms are often nonspecific and related to pain in the plantar surface of the first metatarsal head 2.
- Imaging is crucial for the etiologic diagnosis of hallux sesamoid complex pathology, which includes sesamoiditis, and has implications for patient management 2.
- A practical multimodality approach for the diagnosis of hallux sesamoid pathologies, including sesamoiditis, can be proposed after reviewing anatomical key points and pathologies affecting the hallux sesamoid complex 2.
- Conditions affecting sesamoids, such as sesamoiditis, can be divided into two major groups: intrinsic anomalies (sesamoid bone being the center of the pathologic process) and extrinsic anomalies (diseases secondarily involving sesamoid bones) 2.
- Imaging techniques, such as those used for turf toe and sesamoiditis, are essential for radiologists to understand, as they play a critical role in diagnosing and managing these conditions 3.