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A Journal on Internal Medicine and Pharmacology

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 June;172(6):529-33

language: English

Successful non-surgical management of refractory Hallucal sesamoiditis

Frey M. 1, Koehle M. S. 2

1 Department of Family Medicine, University of Calgary, Calgary, AB, Canada;
2 Allan McGavin Sport Medicine Centre, School of Kinesiology and Division of Sports Medicine, University of British Columbia, Vancouver, Canada


Sesamoid bones are embedded in tendons at joints throughout the body. They include the hallucal sesamoids which can be fractured or become inflamed due to factors including repetitive trauma. Although this can lead to substantial patient morbidity, imaging studies are often useful to elucidate the underlying pathology and guide treatment which includes conservative management, as well more invasive procedures such as corticosteroid injection or surgical excision. A female 63-year-old runner presented with suspected sesamoiditis that had failed numerous conservative treatments. Her work-up included a bone scan and computed tomography. Her symptoms persisted despite further non-invasive treatment including activity modification, orthotics and a trial of immobilization. As she wanted to avoid surgery, she agreed to a trial of injection local corticosteroids and quickly responded after two treatments. She was able to return to competitive running. Both injections were well-tolerated and no complications were noted. On follow-up four months later, the patient noted minimal residual discomfort despite resuming normal activity. She was asymptomatic and still running at 18 months following her final injection. These results suggest that therapeutic local corticosteroid injection should be considered in the treatment of refractory sesamoiditis prior to surgical excision.

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