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

Abstract

Background Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis. Methods This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data. Results A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms. Conclusion Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient’s social factors, symptomology, and lower limb biomechanics.

The development of recommendations for the assessment and management of sesamoiditis by podiatrists: A Delphi and content validity study

“…A total of 111 statements were generated based on the responses from the 18 panellists who completed the round one survey. An additional seven statements were generated from the research team's recent focus group study [ 11 ], resulting in a total of 118 statements. These statements were organised by assessment ( n = 56 statements) and management ( n = 62 statements) approaches (see Supporting Information S1 ).…”

“…The round one Delphi survey remained open for 6 weeks to allow for the recruitment of an adequate number of panel members. A list of Delphi statements was then compiled based on data generated from these open‐ended questions as well as data from a recent qualitative focus group study conducted by the research team [ 11 ]. Every assessment and management approach shared by panellist members was deemed useful and included as a Delphi statement, regardless of the number of panellists who shared it.…”

“…Reminder emails continued to thank panellists for their contribution to the study, encouraged them to complete each survey round and emphasised the importance of their views. these open-ended questions as well as data from a recent qualitative focus group study conducted by the research team [11]. Every assessment and management approach shared by panellist members was deemed useful and included as a Delphi statement, regardless of the number of panellists who shared it.…”

“…Although sesamoiditis is one of the most common forefoot injuries encountered by podiatrists [ 4 ], there are currently no recommendations to assist podiatrists in their approach to the assessment and management of people with sesamoiditis. In response to the lack of published data on sesamoiditis [ 9 , 10 ], a recent qualitative study involving focus group discussions between experienced podiatrists in Aotearoa New Zealand [ 11 ] found that podiatrists are guided by advanced clinical experiences and anatomical knowledge of the lower limb when caring for people with sesamoiditis. Their approach to assessing patients with sesamoiditis included both subjective questioning and a range of objective examinations focused on diagnosis and identification of contributing biomechanical factors.…”

“…systemic disease, or when treatment strategies are beyond the scope of the podiatrist's practice. Previous qualitative work has shown that podiatrists are hesitant to directly refer people with sesamoiditis for more invasive therapies due to concerns about low success rates and ongoing complications[11]. In fact, surgical management of sesamoiditis is not strongly evidence-based[28] and is associated with a number of complications, including the development of hallux valgus, hallux varus, hallux extensus, claw-toe deformity and weakness of hallux propulsion and gait changes[5,29,30].Importantly, the recommendations developed from this study reflect the perspectives of each panel member, which, in the absence of research-based evidence on the assessment and management of sesamoiditis, was influenced primarily by their own expert opinion and clinical experience.…”