Sesamoiditis

Show notes:
DDX: adventitial bursitis, #, FHB tear, synovitis, capsulitis (don’t bother with a moon boot for capsulitis and synovitis).

If acute sesamoiditis, moonboot until diagnosis confirmed and avoid to avascular necrosis.
Moonboot for 2 weeks, maximum -> then flat shoes for 6 wks.
No point moonbooting if they have already tried all this.
If reconditioning to heels after all this, start with 15 mins a day around home.

Sesamoiditis is environmental and load related. Individual mechanics can also have an effect (often forefoot valgus with plantarflexed 1st).

Treatment:
– load modification: e.g change to cycling/swimming
– Educate patient that there will be good days and bad days.
– U-pads
– Break inflammation/pain cycle with moonboot and U-padding
– Progress to shoes that facilitate propulsion. Not super rigid or flexible. E.g. rocker with some flex at the toe.
– Consider orthoses with 1st ray cut out and met dome
– FMT