Subhallucal Interphalangeal Sesamoiditis: A Rare Cause of Chronic Great Toe Pain

Abstract

Subhallucal interphalangeal sesamoiditis presenting as chronic great toe pain is a rarely reported clinical entity, being often overlooked and misdiagnosed for other pathologies. By altering the biomechanics of the movements at great toe, the interphalangeal sesamoid is prone to various painful pathologies like trauma, infection, degeneration, osteonecrosis and inflammation. Imaging plays an important role in narrowing down the differentials and guiding for appropriate therapy. Herein, we present a neglected case of hallucal interphalangeal sesamoiditis presenting as a case of chronic great toe pain and discuss the role of Magnetic resonance imaging (MRI) and Computed tomography (CT) scan in its diagnosis.

Keywords: CT scan; MRI; Sesamoid.

[Table/Fig-1]:

Plain radiograph of right Foot AP (A) and lateral (B) views reveal a small well defined bone fragment at the plantar aspect of proximal phalanx of great toe (arrow)

[Table/Fig-2]:

Magnetic Resonance Imaging. T2- weighted sagittal (A) and coronal (B) and T1- weighted coronal (C) images reveal a sesamoid bone embedded superficially within the flexor hallucis longus tendon (white arrow). STIR weighted sagittal (D) and coronal (E) images reveal hyperintense marrow signals within the subhallucal sesamoid (black arrow)

[Table/Fig-3]:

CT scan coronal (A) and sagittal (B,C) images accurately localises the well defined smooth edged bone ossicle at the plantar aspect of the proximal phalanx of great toe