Bilateral Sesamoiditis as First Manifestation of Gout

Abstract

Sesamoiditis secondary to gout is an extremely rare condition with few case reports in the literature. It is an important differential diagnosis because the treatment depends on targeted therapy, unlike the main causes of sesamoiditis that often involves immobilization with special orthoses and prescription of anti-inflammatory drugs. We report here a case of a 38-year-old male, athlete, with bipartite medial sesamoid, who had insidious pain in the base of the left hallux. Laboratory tests showed no alterations, and imaging examinations demonstrated sesamoiditis with suspicion of stress fracture. The patient was initially prescribed an immobilization boot and analgesic and anti-inflammatory drugs, but he did not respond to the measures taken. After the onset of the same condition in the contralateral foot and getting the same imaging findings, we began an investigation of systemic disease, focusing on gout, because of a positive family history, which was confirmed by dual-energy computed tomography.

Orthopaedic Management of Gout

“…Several case reports have described gout as a potential cause of sesamoid pain, with all reported cases in younger adults aged 17 to 41 years. 41-44 In these cases, gout was a diagnosis of exclusion and ultimately confirmed with histologic examination at the time of surgery. None of these patients reported a history of gout or had a preoperative elevated uric acid level.…”

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

“…Sesamoiditis is a term describing inflammation of the sesamoid bones and surrounding soft tissue structures on the plantar aspect of the first metatarsophalangeal joint (1MTPJ) [1,2]. Activities involving repetitive stress, such as running, jumping, and forced dorsiflexion of the 1MTPJ, subject the sesamoid bones to greater ground reaction forces, which have been reported to contribute to local irritation and inflammation [1,[3][4][5]. Consequently, sesamoiditis is more common in athletes, accounting for 2.2% of all foot injuries and 18.3% of all 1MTPJ injuries [6], and is a condition commonly encountered by podiatrists.…”

“…Clinically, sesamoiditis is simply described as a sudden or insidious onset of localised or diffuse pain on the plantar aspect of the 1MTPJ [4, 7]. This can result in substantial physical limitations for patients, including difficulty in weightbearing through the 1MTPJ during the propulsive phase of the gait cycle [1, 2, 5, 7, 8]. Although the clinical presentation of sesamoiditis has been described in the existing literature, there is a lack of guidance on the assessment and diagnosis of sesamoiditis.…”

“…Non‐surgical management options that have been documented for sesamoiditis include immobilisation techniques via splints, shoes, moonboots, and special orthoses, as well as the use of anti‐inflammatory drugs, rest, activity modification, cortisone injections, and radial shockwave therapy [1, 2, 5, 9]. However, the effectiveness of various conservative interventions for sesamoiditis has not been established, and there are currently no published recommendations or guidelines for their use in clinical practice.…”