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Dear all.
Excuse my ignorance but:
Is it possible that sesamoiditis can occur in a 70year old female? From what i know it is a patholoogy that is typically related with active people, mostly athletes. Is it more likely that the tenderness under the 1st MPjt derives from osteoarthritic changes in the joint?
Many thanks

 

I can't recall specifically if I have seen this at this age, but can not see why it could not. BUT, consider the ddx - this is from my notes:

 

I have some 70 year old female patients that are very active. Yes, even 70 year old women can get sesamoiditis given the right circumstances (i.e. high first ray dorsiflexion stiffness). In addition, at this age, the plantar fat pad atrophy that occurs may be an inciting factor.

 

Kevin,

Why would high first ray dorsiflexion stiffness result in only tibial sesmoiditis, and not fibular sesmoiditis?

Stanley

 

Stanley:

I never said that a foot with increased first ray dorsiflexion stiffness would have an increased risk of only developing tibial sesamoiditis and not fibular sesamoiditis? :confused: Did I?? :eek:

 

Kevin,

You are correct, you didn't say that :eek: . So what is the mechanism for tibial versus fibular sesmoiditis?

Stanley

 

I can think of a few possible mechnical etiologies that may cause one sesamoid to become irritated more than the adjacent sesamoid:

1. Difference in sizes of sesamoid.

2. Relative shape of first metatarsal head plantar aspect.

3. Relative frontal plane position of first metatarsal head.

4. Relative position of sesamoids to plantar first metatarsal head and crista.

5. Inciting trauma to one sesamoid only.

 

Kevin,

Thank you for your quick reply. I am clear on all the factors that you mention except: Relative frontal plane position of first metatarsal head.

Could you explain what you mean in greater detail?

Stanley

 

If the first metatarsal head is relatively everted within the frontal plane, then the medial sesamoid will be more likely to have increased compression forces from ground reaction force (GRF). If the first metatarsal head is relatively inverted within the frontal plane, then the lateral sesamoid will be more likely to have increased compression forces from GRF. Of course, this is assuming that the sesamoids are constantly positioned relative to the plantar first metatarsal head and crista which we know they aren't (at all times).