Subhallucal Interphalangeal Sesamoiditis: A Rare Cause of Chronic Great Toe Pain
This study focused on a neglected case of hallucal interphalangeal sesamoiditis presenting as a case of chronic great toe pain; the role of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan in its diagnosis was discussed.
A 49-year-old man complained of having pain in his right forefoot for five years, predominantly over the plantar aspect of the hallux, in the region of the interphalangeal joint.
A bus driver by occupation, he complained of this pain worsening during application of breaks while driving.
Previous MRI scans, dating back to 3 years, were reported to be normal.
Physical examination of the patient revealed mild antalgic gait.
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A clinical examination revealed severe tenderness and discomfort on palpation over the first interphalangeal joint at the plantar aspect of the proximal phalanx with no obvious swelling or redness.
Plain radiograph of foot revealed a small bone fragment at the plantar aspect of the head of proximal phalanx.
MRI revealed a smooth-edged and well corticated triangular ossicle embedded superficially within the tendon of flexor hallucis longus on the plantar aspect of interphalangeal joint of great toe with bone remodelling in the form of exaggerated concavity of the adjacent head of proximal phalanx of great toe.
Fat suppressed short tau inversion sequences revealed marrow oedema within the sesamoid bone.
Physiological fluid was seen in interphalangeal and metatarsophalangeal joints of great toe.
Correlated Computed Tomography (CT) confirmed the location and smooth margins of the subhallucal sesamoid bone.
Based on the clinical and imaging findings, a diagnosis of hallucal interphalangeal sesamoiditis was made.
Often, lack of awareness of this particular entity leads to misdiagnosis, delayed treatment and contributes to significant morbidity.
The condition is usually treated conservatively and surgery is reserved for intractable cases.
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References:
- Sandeep Kumar, Rajagopal Kadavigere, Radha Puppala, Anurag Ayachit, Ruchika Singh (2015) Subhallucal Interphalangeal Sesamoiditis: A Rare Cause of Chronic Great Toe Pain. Journal of Clinical and Diagnostic Research: May 2015, Vol. 9, No. 5, pp. TD01-TDO2, DOI: 10.7860/JCDR/2015/13210.5870
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