Re: Medial Sesamoid problems or Compressed Nerve?
Foot Doc - thank you for the feedback. Attached are results from an MRI and CAT on my left foot. The pain is exclusively near the medial sesamoid, plantar proper digital nerve, FHL, etc. Any other thoughts?
MRI - Marrow edema and subchondral cystic change within distal aspect of lateral sesamoid, apparent overlying chondral loss and prominent osteophytes arising from the plantar aspect of the of first metatarsal head, are indicative of advanced osteoarthropathy of sesamoid joint. Medial sesamoid appears bipartite. Small focus of subchondral edema within base of first metatarsal and larger regions of edema within base of second metatarsal and within medial cuneiform appear related to advanced to osteoarthitis of tarsometatarsal joints. Considerable fluid present within flexor longus tendon sheath proximal to Knot of Henry. FDL, peroneus longus and extensor tendons are unremarkable. Intrinsic muscles of foot are normal.
1. Advanced Osteoarthrosis of lateral sesamoid metatarsal joint and first/second tarsometatarsal joints.
2.Tenosynovitis of FHL tendon proximal to Knot of Henry.
CAT lower extremity
A fragmented medial first metatarsal sesamoid bone is present, likely a bipartite sesamoid, although an incomplete fracture of the proximal component cannot be excluded. Recommend clinical correlation with point tenderness. Of note, the right sesamoid bones are intact and no bipartite sesamoid bone is identified within the visualized right foot. There is joint space narrowing of the metatarsal-sesamoid articulation involving both the medial and lateral sesamoid bones, consistent with osteoarthitis. Mild subchondral lunency within the lateral articulation is demonstrated. There is also is first metatarophalangeal joint space narrowing with small marginal spurs. No prominent spur is present off the medial base of the proximal phalanx. A mild hallux valgus deformity is present, although the foot was not imaged in standard radiographic projection for this assessment.
1. First metatarsal-sesamoid and metatarsophalangeal osteoarthitis, moderate in degree. No large plantar spur identified.
2. probable bipartite medial sesamoid with a fracture felt less likely, but recommend clinical correlation with point tenderness.