Where is sesamoiditis pain typically located?

Sesamoiditis Pain Location

Sesamoiditis pain is typically located under the first metatarsophalangeal joint, specifically at the hallucal sesamoid bones. 1

Anatomical Location Details

• Pain is concentrated beneath the first metatarsophalangeal (MTP) joint at the base of the big toe, where the sesamoid bones are embedded in the flexor hallucis brevis tendon 1, 2
• The sesamoid apparatus functions as a pulley system to help pull the big toe down against the ground during walking, making this area susceptible to repetitive stress 2
• Patients typically experience pain directly under the ball of the foot, which may worsen with activities that place pressure on the forefoot, such as walking barefoot, running, or dancing 3

Clinical Presentation

• Pain is often insidious in onset and worsens with weight-bearing activities 3
• Tenderness to palpation directly over the sesamoid bones is a hallmark finding 4
• Pain may be accompanied by swelling and limited range of motion in the first MTP joint 5
• Symptoms typically worsen with activities that involve pushing off from the forefoot, such as running or jumping 3, 2

Diagnostic Considerations

• It's crucial to differentiate sesamoiditis from other causes of forefoot pain, such as Morton's neuroma, which typically presents with pain between the third and fourth metatarsal heads rather than under the first MTP joint 1, 6
• Imaging studies can confirm the diagnosis:
  • MRI shows bone marrow edema and stress-related changes in the affected sesamoid 1
  • Bone scintigraphy reveals increased uptake in the affected sesamoid bone 1, 2
  • CT helps distinguish between sesamoiditis, stress fractures, and bipartite sesamoids 1

Differential Diagnosis

• Other conditions that may cause pain in a similar location include:
  • Acute fractures or stress fractures of the sesamoid bones 3, 7
  • Avascular necrosis of the sesamoids 7
  • Chondromalacia 3
  • Gout affecting the sesamoid bones 4
  • Flexor hallucis brevis tendinitis 5

Common Pitfalls

• Failing to recognize bipartite sesamoids (a normal anatomical variant) and misdiagnosing them as fractures 1, 4
• Not considering systemic conditions like gout that can manifest as sesamoiditis 4
• Overlooking rare conditions such as congenital absence of a sesamoid bone, which can also cause pain in the same location 5
• Misdiagnosing sesamoiditis as Morton's neuroma due to proximity of pain location in the forefoot 1, 6