The Assessment and Management of Sesamoiditis in Aotearoa New Zealand

Abstract

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

Research Team: Preeti Kaur (presenter), Dr Sarah Stewart, A/Prof Matthew R Carroll.

Background: Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar first metatarsophalangeal joint (1MTPJ). 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 patients with sesamoiditis.

Methods: Focus group discussions with registered podiatrists took place online. Questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage it. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data.

Results: Twelve 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) managing patients who don’t respond to podiatry treatment.

Conclusion: Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience, as well as the patient’s social factors, symptomology, and lower limb biomechanics.