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Dear all.
Excuse my ignorance but:
Is it possible that sesamoiditis can occur in a 70year old female? From what i know it is a patholoogy that is typically related with active people, mostly athletes. Is it more likely that the tenderness under the 1st MPjt derives from osteoarthritic changes in the joint?
Many thanks
Is it possible that sesamoiditis can occur in a 70year old female? From what i know it is a patholoogy that is typically related with active people, mostly athletes. Is it more likely that the tenderness under the 1st MPjt derives from osteoarthritic changes in the joint?
Many thanks
I can't recall specifically if I have seen this at this age, but can not see why it could not. BUT, consider the ddx - this is from my notes:
Quote:
Other Causes of Sesamoid Pain
Arthritis:
Osteoarthritis may occur in the sesamoid articulation. Erosion of cartilage in case of sesamoid chrondomalacia have been reported and may be an early stage of osteoarthritis. Swelling is often present on examination. MPJ motion may be restricted; pain on palpation and forced dorsiflexion of the joint. On x-ray there may be osteophytes, non-uniform loss of joint space, subchondral sclerosis, and a flattening of a portion of the sesamoid bones.
Rheumatoid arthritis typically causes bone resorption and erosions, uniform joint space narrowing and soft tissue swelling
Gout may also affect the joint
Infection:
Osteomyelitis may occur following a puncture wound.
Nerve Compression:
The digital nerves in the region of the sesamoid may be impinged and the pain may be difficult to differentiate from localised sesamoid pain. A positive Tinel’s sign and decreased sensation may be present. Surgical excision may be needed.
Bipartite Sesamoids and Fractures:
Reports of the prevalence of bipartite sesamoids ranges from 6% to 30%, with most being medial sesamoids. Medial sesamoids can be in up to 4 parts, but it is rare for lateral sesamoids to be in more than 2 parts. Fractures are rare and it is often difficult to differentiate a fracture from bipartite sesamoids.
A painful bipartite sesamoid will often be related to minor trauma with gradual onset, whereas a fracture will have an acute onset. Fractures are more likely to involve the medial sesamoid.
Bone scintigraphy may distinguish between a fracture and other causes.
Fractures will need 4-8 weeks of immobilisation.
Stress Fracture:
Stress fractures can occur in the sesamoids can occur. Onset will be gradual. X-rays will generally be negative and bone scintigraphy may be positive.
Osteochondritis/avascular necrosis/Treve’s disease:
Characterised by pain, tenderness to palpation and osseous mottling or fragmentation on x-ray. The cause is unclear, may be post-traumatic. MRI will show low marrow signal intensity. Management is immobilisation for 4-8 weeks. May need surgical excision if conservative management is ineffective.
Planter hyperkeratosis:
Callus beneath the metatarsal head can cause pain in the region and may co-exist with a sesamoid problem.
Flexor Hallucis Longus Tendonitis:
The tendon may become inflamed in the region of the sesamoids. It is more common in ballet dancers, due to the forced range of dorsiflexion of the first MPJ during some positions. Physical therapy modalities are much more effective for FHL tendonitis (not so effective against sesamoiditis).
Myofascial pain syndrome:
Pain referred to sesamoid area from trigger point in intrinsic muscles
__________________ Craig Payne
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Dear all.
Excuse my ignorance but:
Is it possible that sesamoiditis can occur in a 70year old female? From what i know it is a patholoogy that is typically related with active people, mostly athletes. Is it more likely that the tenderness under the 1st MPjt derives from osteoarthritic changes in the joint?
Many thanks
I have some 70 year old female patients that are very active. Yes, even 70 year old women can get sesamoiditis given the right circumstances (i.e. high first ray dorsiflexion stiffness). In addition, at this age, the plantar fat pad atrophy that occurs may be an inciting factor.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Why would high first ray dorsiflexion stiffness result in only tibial sesmoiditis, and not fibular sesmoiditis?
Stanley
Stanley:
I never said that a foot with increased first ray dorsiflexion stiffness would have an increased risk of only developing tibial sesamoiditis and not fibular sesamoiditis? Did I??
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Sesamoiditis
Did I?? 
. So what is the mechanism for tibial versus fibular sesmoiditis?
Hybrid Mode
