The Assessment and Management of Sesamoiditis in Aotearoa New Zealand

Links

Abstract

Background: Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint. Sesamoiditis causes pain and major physical limitations for patients, particularly during the propulsive phase of gait (toe-off). Podiatrists play an important role in the assessment and management of patients with sesamoiditis. However, there are currently no recommended objective clinical tests that should be considered when assessing and diagnosing sesamoiditis and there are no podiatry-specific guidelines on the management of sesamoiditis. The aims of this study were (1) to explore the views of Aotearoa New Zealand podiatrists on their approaches to assessment and diagnosis of sesamoiditis; and (2) to explore the views of Aotearoa New Zealand podiatrists on their approaches to management of sesamoiditis.

Methods: This qualitative study involved focus group discussions with New Zealand registered podiatrists. Focus groups took place online via zoom and were guided by a detailed focus group interview schedule. Questions were designed to promote discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data.

Results: A total of 12 registered podiatrists participated in one of four focus groups. Four themes were constructed relating to the assessment and diagnosis of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1st MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1st MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) managing patients who don’t respond to podiatry treatment.

Conclusion: Despite the absence of any clear recommendations and guidelines on the assessment and management of sesamoiditis, the findings from this study have highlighted that podiatrists in Aotearoa New Zealand demonstrate an advanced analytical approach based on thorough clinical reasoning when caring for patients with sesamoiditis. The results from this study provide an increased understanding of current assessment and management practices used by podiatrists which is an important step in the development of recommendations that help guide podiatric assessment and management of sesamoiditis.

Cited Works (5)

Year	Entry
2015	Schein AJ, Skalski MR, Patel DB, White EA, Lundquist R, Gottsegen CJ, Forrester DM, Matcuk GR Jr. Turf toe and sesamoiditis: what the radiologist needs to know. Clin Imgaging. May–June 2015;39(3):380-389.
2000	Chou LB. Disorders of the first metatarsophalangeal joint: diagnosis of great-toe pain. Phys Sportsmed. 2000;28(7):32-45.
2010	Bancroft LW, Anderson RB. Traumatic dislocation of the tibial sesamoid of the hallux. Orthopedics. 2010;33(9):690-693.
2017	York PJ, Wydra FB, Hunt KJ. Injuries to the great toe. Curr Rev Musculoskel Med. March 2017;10(1):104-112.
2020	Lievers WB, Goggins KA, Adamic P. Epidemiology of foot injuries using National Collegiate Athletic Association data from the 2009–2010 through 2014–2015 seasons. J Athl Train. February 2020;55(2):181-187.