Sesamoiditis is a common problem in athlete with high loads under the first metatarsophalangeal joint. It is not really a sesamoiditis, as it is an inflammation of the soft tissues around the sesamoid bones at this joint. The pain of sesamoiditis is usually on direct palpation of the area. Imaging is sometimes useful to rule out a fracture of the sesamoid bone. The reason for the higher loads is due to the structure of the foot, most common a higher arched foot with a plantarflexed first ray which when combined with higher levels of activity can create this problem. Sesamoiditis can also be more common in sports that involve pivoting on the first metatarsophalangeal joint such as tennis. The initial treatment if sesamoidtis is the use to offloading techniques in foot orthoses to reduce the load on this structure. Sometimes adding an anti-shear cover to the foot orthoses will help with the pivoting motions. If conservative measures are not successful, then surgical management such as elevating the first metatarsal or the more drastic measure of removing the sesamoid have been tried for sesamoiditis.
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