Sesamoid Pain: Primary or Secondary to Swelling

This MRI image of the ball of the foot highlights swelling under the first metatarsal produced by a joint sprain but causing palpable soreness on the sesamoid bones. The xrays showed a possible fracture of the tibial sesamoid and surgery was being considered. The MRI clearly shows that both sesamoids are fine (to the left and right of the arrow under the first metatarsal head). This patient actually sprained the 3rd metatarsal phalangeal joint (see the reactive swelling or whiteness) and was favoring that area placing weight abnormally on the big toe joint.