Right foot pain while walking • no erythema or edema • no evidence of structural abnormalities • Dx?
Sesamoiditis is typically managed with a combination of ice, analgesics, activity modification, and/or orthoses.2 Of course, the key to successfully treating sesamoiditis (and all musculoskeletal injuries) is to not only make the diagnosis, but to find the underlying cause in order to prevent continued—or worsening—pain.
Our patient agreed to close follow-up rather than imaging. We established that the only inciting event was the cracking of her MTPJ, and that she should try to eliminate this action before trying other interventions. Our patient stopped cracking her MTPJ and her pain completely resolved in 2 weeks. She remains symptom-free.
THE TAKEAWAY
Ask about knuckle cracking when taking the history of a patient who presents with sesamoiditis, which is characterized by chronic pain and inflammation of the hallucal sesamoids.
