title: [A long-distance runner with a painful sesamoid bone in the forefoot].
abstract: A 38-year-old long-distance runner presented with pain in the left medial forefoot. In the presence of such symptoms, consideration should be given to a disease of or injury to a sesamoid bone. Radiology revealed a fracture line through the medial sesamoid bone under the first metatarsophalangeal joint. Conservative treatment was initially ineffective. Ultimately, local injections of lidocaine-methylprednisolone at the site of the pain, in the metatarsophalangeal joint and in the fracture line brought relief. In the diagnosis of patients with pain in the medial forefoot, apart from the patient's history and a physical examination, a skyline X-ray can be helpful to reveal a fractured or bipartite sesamoid. Almost all conditions affecting the sesamoids improve in the long run with conservative treatment. Besides reduction of weight-bearing pressure on the affected sesamoid, NSAIDs and ice massage, special attention should be paid to the foot (postural deformities), the shoe (inlays, sesamoid pad, shock absorption, stiff sole) and running on a soft surface. Insufficient therapeutic results may be due to osteonecrosis or non-union. These and persistent pain may, as a last resort, require surgical intervention such as screw fixation in case of a fracture or sesamoidectomy.
authors.affiliation: Universitair Medisch Centrum, Afd. Sportgeneeskunde, Postbus 85.500, 350o8 GA Utrecht.
authors.forename: I
authors.initials: I
authors.lastname: Christiaans
authors.forename: G
authors.initials: G
authors.lastname: Stapper
authors.forename: F J G
authors.initials: FJ
authors.lastname: Backx
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000293:injuries; D010146:Pain / Q000209:etiology; D011859:Radiography; D012420:Running / Q000293:injuries*; D012716:Sesamoid Bones / Q000000981:diagnostic imaging* / Q000293:injuries*
vernacular_title: Een duurloper met een pijnlijk sesambeentje in de voorvoet.