Simply put, sesamoiditis
is inflammation of the sesamoid bones. In anatomy, a sesamoid bone is a bone
embedded within a tendon.
Sesamoid bones can be
found on joints throughout the body, including:
• In the knee
— the patella (within the quadriceps tendon).
• In the hand
— two sesamoid bones are commonly found in the distal portions of the first
metacarpal bone (within the tendons of adductor pollicis and flexor pollicis
brevis). There is also commonly a sesamoid bone in distal portions of the
second metacarpal bone.
• In the
wrist — The pisiform of the wrist is a sesamoid bone (within the tendon of
flexor carpi ulnaris).
• In the foot
— the first metatarsal bone usually has two sesamoid bones at its connection to
the big toe (both within the tendon of flexor hallucis brevis). In some people,
only a single sesamoid is found on the first MTP.
In humans (and animals
like horses), it occurs on the bottom of the foot, just behind the large toe.
There are normally two sesamoid bones on each foot. Sometimes sesamoids can be
bipartite, which means they’re comprised of two separate pieces. The sesamoids
are roughly the size of small jelly beans.
The sesamoid bones act as
a fulcrum for the flexor tendons, the tendons which bend the big toe downward.
Periostitis, also known
as periostalgia, is a medical condition caused by inflammation of the
periosteum, a layer of connective tissue that surrounds bone. The condition is
generally chronic, and is marked by tenderness and swelling of the bone and an
aching pain.
Usually periostitis
occurs along with sesamoiditis, and the suspensory ligament may also be
affected. This periostitis can actually be the cause of inflammation in the
area once it occurs.
Osteophytes or new bone
with jagged edges can form that push on the tendon in such a way as to cause
inflammation as well. Once this occurs, the problem may be chronic. This is
very important for you to understand as you’ll later read in this book.
Inflammation, in most
cases, is not your friend and must be treated vehemently.
In summary, sesamoiditis
results in inflammation, pain, and eventually bone growth directly in the area
of the sesamoids.
In addition to experiencing
inflammation and pain, the sesamoid bone may fracture and can be difficult to
pick up on x-ray. A bone scan is a better alternative.
Make sure you understand
the distinction between x-ray and a bone scan because you’ll want to be well
versed in these technologies if you see a doctor.
Most podiatrists will
just take an x-ray, which in most cases is relatively inaccurate. Why do they
take an x-ray? Maybe for insurance reasons, costs or because they don’t have a
bone scan machine. Either way, choose a provider whose able to do a bone scan
if necessary.
What is a bone scan?
A bone scan is a test to
help find the cause of your foot pain. It is done to find damage to the bones,
find cancer that has spread to the bones or to follow problems such as infection
and trauma to the bones. A bone scan can often find a problem - days to months
earlier than a regular x-ray test.
For a bone scan, a
radioactive substance is injected into a vein in your arm. This substance,
called a tracer, travels through your bloodstream and into your bones. This
could take several hours.
A special camera takes
pictures of the tracer in your bones. Areas that absorb little or no amount of
tracer appear as dark or "cold" spots. This could show a lack of
blood supply to the bone or certain types of cancer.
Areas of fast bone growth
or repair absorb more tracer and show up as bright or "hot" spot in
the pictures. Hot spots may point to problems such as arthritis, a tumor, a
fracture, or an infection.
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