Korean J Pain.  2013 Apr;26(2):173-176. 10.3344/kjp.2013.26.2.173.

Symptomatic Hallucal Interphalangeal Sesamoid Bones Successfully Treated with Ultrasound-guided Injection: A Case Report

• Shin HY
• Park SY
• Kim HY
• Jung YS
• An S
• Kang DH

• KMID: 1978664
• DOI: http://doi.org/10.3344/kjp.2013.26.2.173

Abstract

The hallucal interphalangeal sesamoid bone is usually asymptomatic, but it is not uncommon for it to be symptomatic in cases of undue pressure, overuse, or trauma. Even in symptomatic cases, however, patients often suffer for extended periods due to misdiagnosis, resulting in depression and anxiety that can steadily worsen to the extent that symptoms are sometimes mistaken for a somatoform disorder. Dynamic ultrasound-guided evaluations can be an effective means of detecting symptomatic sesamoid bones, and a simple injection of a small dose of local anesthetics mixed with steroids is an easily performed and effective treatment option in cases, for example, of tenosynovitis.

Keyword

flexor hallucis longus tendon; foot pain; injection; interphalangeal sesamoid; somatoform disorder; ultrasound

MeSH Terms

Anesthetics, Local
Anxiety
Depression
Diagnostic Errors
Humans
Sesamoid Bones
Somatoform Disorders
Steroids
Tenosynovitis
Anesthetics, Local
Steroids

Figure

• 

  Fig. 1 The illustration of the direction of pain which started at her great toe extending to her calf.

• 

  Fig. 2 The ultrasound image of a sesamoid bone (arrow) under the flexor hallucis longus tendon in longitudinal plane.

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  Fig. 3 Overlooked hallucial interphalangeal sesamoid bones (arrows) on plain radiographs. (A) Anteroposterior view. (B) Lateral view.

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