A 44-year-old man presented to the Emergency Department after having injured his right great toe while stepping into a hole at the beach. He was able to ambulate on his heel, but had significant pain while ambulating on the ball of his foot. Physical examination reflected significant discomfort with palpation over the ball of the foot and with ranging the great toe. He had an intact neurovascular examination and had no other focal findings. Plain radiographs of the foot reflected an acute fracture of the sesamoid bone at the metatarsal-phalangeal joint of the great toe (Figure 1, Figure 2). Re-examination of the patient confirmed this region as the focus of his discomfort. Bone radiographs need to be looked at systematically in order not to miss atypical fractures such as this of a sesamoid bone.
*Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California, USA
Reprint Address: Gary M. Vilke, MD, UCSD Medical Center, 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, USA
☆Visual Diagnosis in Emergency Medicine is coordinated by Stephen R. Hayden, MD, of the University of California San Diego Medical Center, San Diego, California
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