Osteoarthritis 1st MPJ w/ sesamoid involvement

Case submitted by Daniel Evans, DPM, FACFAOM

A 63 y/o male has pain at level of 1st metatarsal phalangeal joint consistent with osteoarthritis.

Dorsoplantar projection demonstrates 1st MPJ narrowing with osteophyte formation lateral aspect of first metatarsal head as well as base of proximal phalanx.  Lateral projection demonstrates osteophytes on both the proximal phalanx and base of the first metatarsal.  What makes this case interesting is that the axial sesamoid projection demonstrates a marked hyperostosis off of the plantar aspect of the tibial sesamoid.  If we did not take this projection, we would not have taken into consideration this component of his pathology.