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Marrow Edema of Distal Phalynx and Sesamoiditis

Discussion in 'General Issues and Discussion Forum' started by martenskier, Mar 19, 2024.

  1. martenskier

    martenskier Welcome New Poster


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    A 20-year-old male presents explaining chronic pain in the fibular sesamoid region of the left foot for 2 years. He had an MRI 1 year ago showing inflammation of that sesamoid. He has tried three months of offloading, dancer pads, orthoses, pretty much everything. I proceeded to order an MRI.

    MRI comes back showing potential osteomyelitis of the complete distal phalanx. I checked the MRI and saw significant marrow edema in the area. The sesamoid complex seems nonremarkable. I'm considering a bone marrow biopsy of the distal phalanx to rule out a bone infection. Any other thoughts on treatment? Have you ever seen a case similar to this before?
     
  2. efuller

    efuller MVP

    No I have not seen anything like that. It does remind me of the saying "Don't treat the x-ray". Are you sure your patient was compliant with the treatment. When I was in my 20's I remember playing football with a walking cast on my leg. Were the orthotics designed to off weight the first met head? Did the orthotics show high usage and/or high loads on the first met head? Rocker shoes? Was there a lot of wear on the plantar surface of the CAM walker?
     
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