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1
Groenewald, H. B., W. M. Wagner, and R. M. Kirberger. "A radiological study of the sesamoid bones and os meniscus of the cheetah (Acinonyxjubatus)." Veterinary and Comparative Orthopaedics and Traumatology 13, no. 04 (2000): 172–77. http://dx.doi.org/10.1055/s-0038-1632656.
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SummaryA radiological study of the sesamoids was undertaken in differing numbers of joints from 10 cheetahs. Each sesamoid was described and measured. Sesamoids were not found in the elbow and tarsal joints. A sesamoid was found in the abductor digiti 1 longus muscle as well as paired sesamoids were found at the interosseous muscle insertions palmarly of digits #1–5 and plantarly of digits #2–5. There were significant differences between abaxial and axial lengths of some of these sesamoids and the palmar sesamoids were significantly shorter than their plantar counterparts. In the stifle, a patella, a popliteal and two gastrocnemius sesamoids were present. The lateral gastrocnemius sesamoid was significantly longer than the medial one and had a peculiar bilobed appearance. An os meniscus was constantly present in the cranial aspect of the medial meniscus. The shape of the sesamoids and the presence of an os meniscus in the cheetah differed from those seen in the domestic dog and cat and were ascribed to differences in form and function.The radiological appearance of the sesamoids and os meniscus were described in adult cheetahs and compared to the domestic dog and cat. Possible anatomical and physiological factors influencing their appearance are postulated.
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Adibatti, Mallikarjun, Muthiah Pitchandi, and Bhuvaneswari V. "A radiological study of anatomical variants of hallux sesamoids." National Journal of Clinical Anatomy 7, no. 03 (July 2018): 128–33. http://dx.doi.org/10.1055/s-0040-1701726.
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Abstract Background and Aims: Hallux sesamoid bones forms an integral part of the first metatarsophalangeal joint for stability during weight bearing. Hallux sesamoids are paired bones located on the plantar aspect of the first metatarsal head within the flexor hallucis longus tendon. Hallucal sesamoids vary in shape and size; can be single, double, bipartite and multipartite. Traumatic insult to the hallux sesamoids can lead to fracture & dislocation, while majority of symptomatic hallux sesamoids can be treated non-surgically; certain specific injuries require a high index of suspicion, careful management, and surgical intervention. Hence present study was taken up to know the incidence, presence/absence, number and partition of hallux sesamoid to enlighten the surgeons and radiologists in early diagnosis and treatment of cases presenting with history of trauma, pain and fractures of foot. Methods: Retrospective radiographic study on the incidence, anatomical variants & distribution ofhallux sesamoids inlOOO radiographs ofthe foot. Result: Hallux Sesamoid bones were seen plantar to first metatarsal head in 994 radiographs [99.4%], while the absence ofHallucal sesamoids were noted in 6 radiographs [0.6%], Single Hallucal sesamoid were noted in 9 radiographs [0.9%], medial bipartition was noted in 20 radiographs [2%], lateral bipartition was noted in 15 radiographs [1.5%]. Conclusion: Knowledge regarding hallux sesamoids helps us in differentiating the various conditions arising out of fractures of foot bones with overlapping signs and symptoms, from actual involvement of sesamoid bone itself, which assists in the early diagnosis and management of foot pathologies.
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Ponssa, María Laura, and Virginia Abdala. "Sesamoids in Caudata and Gymnophiona (Lissamphibia): absences and evidence." PeerJ 8 (December 18, 2020): e10595. http://dx.doi.org/10.7717/peerj.10595.
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An integrative definition of sesamoid bones has been recently proposed, highlighting their relationship with tendons and ligaments, their genetic origin, the influence of epigenetic stimuli on their development, and their variable tissue composition. Sesamoid bones occur mainly associated with a large number of mobile joints in vertebrates, most commonly in the postcranium. Here, we present a survey of the distribution pattern of sesamoids in 256 taxa of Caudata and Gymnophiona and 24 taxa of temnospondyls and lepospondyls, based on dissections, high-resolution X-ray computed tomography from digital databases and literature data. These groups have a pivotal role in the interpretation of the evolution of sesamoids in Lissamphibia and tetrapods in general. Our main goals were: (1) to contribute to the knowledge of the comparative anatomy of sesamoids in Lissamphibia; (2) to assess the evolutionary history of selected sesamoids. We formally studied the evolution of the observed sesamoids by optimizing them in the most accepted phylogeny of the group. We identified only three bony or cartilaginous sesamoids in Caudata: the mandibular sesamoid, which is adjacent to the jaw articulation; one located on the mandibular symphysis; and one located in the posterior end of the maxilla. We did not observe any cartilaginous or osseous sesamoid in Gymnophiona. Mapping analyses of the sesamoid dataset of urodeles onto the phylogeny revealed that the very conspicuous sesamoid in the mandibular symphysis of Necturus beyeri and Amphiuma tridactylum is an independent acquisition of these taxa. On the contrary, the sesamoid located between the maxilla and the lower jaw is a new synapomorphy that supports the node of Hydromantes platycephalus and Karsenia coreana. The absence of a mandibular sesamoid is plesiomorphic to Caudata, whereas it is convergent in seven different families. The absence of postcranial sesamoids in salamanders might reveal a paedomorphic pattern that would be visible in their limb joints.
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Fontanarrosa, Gabriela, Jessica Fratani, and Miriam C. Vera. "Delimiting the boundaries of sesamoid identities under the network theory framework." PeerJ 8 (August 17, 2020): e9691. http://dx.doi.org/10.7717/peerj.9691.
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Sesamoid identity has long been the focus of debate, and how they are linked to other elements of the skeleton has often been considered relevant to their definition. A driving hypothesis of our work was that sesamoids’ nature relies deeply on their connections, and thus we propose an explicit network framework to investigate this subject in Leptodactylus latinasus (Anura: Leptodactylidae). Through the dissection of L. latinasus’ skeleton, we modeled its anatomical network where skeletal elements were considered nodes while joints, muscles, tendons, and aponeurosis were considered links. The skeletal elements were categorized into canonical skeletal pieces, embedded sesamoids, and glide sesamoids. We inquired about the general network characterization and we have explored further into sesamoid connectivity behavior. We found that the network is structured in a modular hierarchical organization, with five modules on the first level and two modules on the second one. The modules reflect a functional, rather than a topological proximity clustering of the skeleton. The 25 sesamoid pieces are members of four of the first-level modules. Node parameters (centrality indicators) showed that: (i) sesamoids are, in general terms, peripheral elements of the skeleton, loosely connected to the canonical bone structures; (ii) embedded sesamoids are not significantly distinguishable from canonical skeletal elements; and (iii) glide sesamoids exhibit the lowest centrality values and strongly differ from both canonical skeletal elements and embedded sesamoids. The loose connectivity pattern of sesamoids, especially glides, could be related to their evolvability, which in turn seems to be reflected in their morphological variation and facultative expression. Based on the connectivity differences among skeletal categories found in our study, an open question remains: can embedded and glide sesamoids be defined under the same criteria? This study presents a new approach to the study of sesamoid identity and to the knowledge of their morphological evolution.
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Kiter, Esat, Semih Akkaya, B. Alper Kiliç, and Fahir Demirkan. "Distribution of the Metatarsophalangeal Sesamoids in Turkish Subjects." Journal of the American Podiatric Medical Association 96, no. 5 (September 1, 2006): 437–41. http://dx.doi.org/10.7547/0960437.
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No statistically significant pattern of metatarsophalangeal sesamoid distribution has been reported in the literature in relation to genetic pool or group, unilaterality or bilaterality, or sesamoid division. A study was undertaken to evaluate the presence and distribution of the metatarsophalangeal sesamoid bones of the foot in Turkish subjects. A total of 602 foot radiographs from 371 patients without forefoot complaints other than those of the hallux were included in the study. Absence or hypoplasia of the first-ray sesamoids was seen on 0.7% of the radiographs, and second-, third-, fourth-, and fifth-ray sesamoids were present on 2.8%, 0.5%, 1.0%, and 15.1% of the radiographs, respectively. Fifth-ray sesamoids were more prevalent in men (odds ratio, 2.71; 95% confidence interval, 1.52–4.84). The frequency of a normal foot profile (two sesamoids in the first ray) was 83.2%. Divisions of the sesamoids were seen on 4.0% of the radiographs at the first ray and on 20.9% at the fifth ray. Distribution and division of sesamoids were predominantly bilateral (κ = 0.91, 0.91, and 0.95 for the first, second, and fifth digits, respectively; P < .001). (J Am Podiatr Med Assoc 96(5): 437–441, 2006)
6
Sobel, Mark, Jun Hashimoto, Steven P. Arnoczky, and Walther H. O. Bohne. "The Microvasculature of the Sesamoid Complex: Its Clinical Significance." Foot & Ankle 13, no. 6 (July 1992): 359–63. http://dx.doi.org/10.1177/107110079201300613.
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The microvascular anatomy of the sesamoid complex was investigated in 15 cadaver specimens using histology and tissue clearing (Spalteholz) techniques. It was found that both sesamoids appeared equally well vascularized and the vascular supply to each sesamoid originated from two major sources (proximal and plantar) and one minor source (distal). Proximally, vessels originating from the first plantar metatarsal artery enter the sesamoid at its attachment to the flexor hallucis brevis. In addition, vessels enter the plantar surface of the sesamoid near the midline and arborize throughout the bone, anastamosing with the proximal vessels. The distal vascular supply to the sesamoids originates from its distal capsular attachment and appears to contribute minimally to the overall vascular scheme. The lateral attachments of the sesamoids to the plantar plate and joint capsule were relatively avascular. In two bipartite specimens examined, the major blood supply originated from the proximal and distal poles of the sesamoid. No vessels were observed entering the plantar surface of these specimens. The results of this study suggest that injury to the proximal or plantar aspects of the sesamoids could disrupt the vascular supply to these bones. These areas should, therefore, be avoided during the surgical approach to the sesamoids.
7
Yildirim, Yakup, Cengiz C¸abukoglu, Bulent Erol, and Tanil Esemenli. "Effect of Metatarsophalangeal Joint Position on the Reliability of the Tangential Sesamoid View in Determining Sesamoid Position." Foot & Ankle International 26, no. 3 (March 2005): 247–50. http://dx.doi.org/10.1177/107110070502600311.
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Background: Lateral displacement of the sesamoids of the first toe relative to the metatarsal head is a common finding in hallux valgus deformity. Several methods have been described for quantifying the amount of subluxation from anteroposterior radiographs but a tangential sesamoid radiograph has been determined to be the best view to evaluate sesamoid displacement. Method: We evaluated the sesamoid position at different angles of the first metatarsophalangeal (MTP) joint to determine the effect of first MTP joint dorsiflexion on sesamoid position when tangential sesamoid view radiographs are made. Sesamoid positions of 22 feet with hallux valgus were graded from the short axis computed tomography (CT) images obtained with the MTP joint in 0, 35, and 70 degrees of dorsiflexion. Results: Approximation of the sesamoids to reduction was apparent as dorsiflexion of the first MTP joint increased. Conclusion: Different dorsiflexion degrees of the first MTP joint when tangential sesamoid radiographs are made modulate the position of the sesamoids and may lead to misclassification on grading.
8
Kurashige, Toshinori, and Seiichi Suzuki. "Severe Hallux Valgus With Coalition of the Hallux Sesamoids Treated With Modified Lapidus Procedure: A Case Report." Foot & Ankle Specialist 10, no. 6 (April 6, 2017): 567–71. http://dx.doi.org/10.1177/1938640017703187.
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Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only 1 case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart shaped on anteroposterior radiographs and dumbbell shaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heart-shaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, a modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Although delayed union occurred, successful correction of the deformity was achieved. Levels of Evidence: Level IV
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Chamberland, Patricia D. C., Judith W. Smith, and Lamar L. Fleming. "The Blood Supply to the Great Toe Sesamoids." Foot & Ankle 14, no. 8 (October 1993): 435–42. http://dx.doi.org/10.1177/107110079301400802.
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The purpose of this study was to define the intraosseous and extraosseous blood supply of the hallucal sesamoids by studying a total of 10 fresh-frozen, below-knee specimens with no evidence of vascular disease. Most specimens were injected with high grade India ink, cleared using a standard Spalteholz technique, and processed to delineate the extraosseous and intraosseous blood supply to include soft tissue dissection and coronal sectioning. Two additional specimens were injected with blue Mercox acrylic solution to further define the extraosseous vasculature. The major extraosseous blood supply to the sesamoids is via the posterior tibial artery. This vessel then branches into the medial plantar artery which further divides upon entering the medial and lateral sesamoids in their proximal poles. Vessels in the peripheral soft tissues, although abundant, do not seem to penetrate the cortex of the sesamoids. The intraosseous blood supply to the sesamoids seems to be threefold. Mainly, sesamoid arteries enter the lateral and medial sesamoids from the proximal aspect via a single vessel. This proximal vessel proceeds distally with a network of branching. Plantar, nonarticular vessels enter the sesamoids, constituting a second source of vascularity. Finally, small vessels also enter the sesamoids through medial and lateral capsular attachments. Based on this study, a possible explanation for avascular necrosis and nonunion of sesamoids is proposed, and an optimal surgical approach is discussed. A medial operative approach avoiding the proximal pole of the sesamoids will preserve the main arterial source. The plantar surface of the sesamoids should also be avoided. Minimal dissection through the circumferential soft tissue vascular sleeve is recommended.
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Nicholson, A. D., J. O. Sanders, R. W. Liu, and D. R. Cooperman. "Binary and analogue markers of skeletal maturity: clinical utility of the thenar and plantar sesamoids." Journal of Children's Orthopaedics 12, no. 1 (February 2018): 76–83. http://dx.doi.org/10.1302/1863-2548.12.170192.
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Purpose We investigate the thenar and plantar sesamoids as markers of skeletal maturity, and grade appearance using two scales, a binary system (absent or present), and an analogue system that relies upon judging regular changes in morphological appearance. Methods We studied 94 healthy children (49 female and 45 male patients) between ages three and 18 years who had approximately 700 serially acquired sets of radiographs and physical examinations. The children had at least annual radiographs taken of the left hand and left foot. Velocity of growth was calculated and curves were fit to a cubic spline model to determine age of maximum height velocity, or peak height velocity (PHV). Appearance of the plantar and thenar sesamoids was recorded using a binary system classifying the sesamoids as absent or present and an analogue system classifying the sesamoid as absent, present as a small ossification centre or larger than a small ossification centre. Results The plantar sesamoids appear 1.67 years before PHV and reach mature size 1.02 years after PHV. The thenar sesamoids appear 0.32 years before PHV and reach mature size 2.25 years after PHV. The plantar sesamoids are present and thenar sesamoids are absent at a mean 1.5 years prior to PHV. No patients had the thenar sesamoids present while the plantar sesamoids were absent. Conclusion As binary markers, when the plantar and thenar sesamoids are considered together it is possible to localize maturity. As analogue markers, they offer more information. The sesamoids also allow clarification of the calcaneal and Sanders stages. Level of Evidence Not Applicable.
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Munuera, Pedro V., Gabriel Domínguez, and Guillermo Lafuente. "Length of the Sesamoids and Their Distance From the Metatarsophalangeal Joint Space in Feet With Incipient Hallux Limitus." Journal of the American Podiatric Medical Association 98, no. 2 (March 1, 2008): 123–29. http://dx.doi.org/10.7547/0980123.
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Background: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position. Methods: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied. Results: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length. Conclusions: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity. (J Am Podiatr Med Assoc 98(2): 123–129, 2008)
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Kuwano, Takashi, Ryuji Nagamine, Kazuhiro Sakaki, Ken Urabe, and Yukihide Iwamoto. "New Radiographic Analysis of Sesamoid Rotation in Hallux Valgus: Comparison with Conventional Evaluation Methods." Foot & Ankle International 23, no. 9 (September 2002): 811–17. http://dx.doi.org/10.1177/107110070202300907.
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The position of the hallucal sesamoids needs to be included in evaluation of hallux valgus. In order to quantify the rotational position of the hallucal sesamoids, a new weightbearing tangential radiograph was established by means of a specially designed tangential positioning device. This device has a depression, and a tangential radiograph is taken with the metatarsophalangeal joint at 45° dorsiflexion. A lead marker plate is placed on the depression to show the horizontal plane, and the sesamoid rotation angle (SRA) is measured. The SRA is the angle between the tangential line of the most inferior aspect of the medial-lateral sesamoids and the lead marker line. The SRA was compared with values of the four-grade scale and seven-position scale which were measured from the antero-posterior view, with respect to the hallux valgus angle (HVA), by means of conventional methods. Measurements were made of 58 feet in 29 patients with hallux valgus and 64 feet in 32 normal subjects. The SRA showed the highest correlation among the three parameters (r = 0.817). Some cases had a disparity regarding the position of the sesamoids between the tangential view and the AP view due to misclassification on the AP view. We conclude that the scale of position of the sesamoid on the AP view is not valid in some cases, whereas the SRA is useful for assessing quantitatively the rotational position of the hallucal sesamoids in cases of hallux valgus.
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Park, Young Hwan, Chan Dong Jeong, Gi Won Choi, and Hak Jun Kim. "Effect of Bipartite Hallucal Sesamoid on Hallux Valgus Surgery." Foot & Ankle International 38, no. 6 (April 9, 2017): 634–40. http://dx.doi.org/10.1177/1071100717700454.
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Background: Bipartite hallucal sesamoids are often found in patients with hallux valgus. However, it is unknown whether bipartite hallucal sesamoids affect the results of hallux valgus surgery or not. The purpose of the present study was to evaluate the outcomes of chevron osteotomy for hallux valgus with and without bipartite hallucal sesamoid. Methods: A total of 152 patients (168 feet) treated with distal or proximal chevron osteotomy for hallux valgus constituted the study cohort. The 168 feet were divided into 2 groups: bipartite hallucal sesamoid (31 feet) and without bipartite hallucal sesamoid (137 feet). Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), tibial sesamoid position, and first metatarsal length were measured for radiographic outcomes and the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score was measured for clinical outcomes. Results: All radiographic measurements and the AOFAS score showed significant ( P < .05) improvement at the time of final follow-up compared with preoperative measurements in both groups. No significant differences ( P > .05) were found between the 2 groups in terms of HVA, IMA, DMAA, tibial sesamoid position, metatarsal shortening, and AOFAS score on final follow-up. Conclusions: This study suggests that bipartite hallucal sesamoids do not affect the results of hallux valgus surgery. Level of Evidence: Level III, retrospective comparative study.
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Ergun, Selim, Baransel Saygı, İlyas Arslan, and Yakup Yıldırım. "Accessory Lesser Metatarsal Sesamoids in All of the Metatarsophalangeal Joints." Journal of the American Podiatric Medical Association 107, no. 3 (May 1, 2017): 223–25. http://dx.doi.org/10.7547/15-195.
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Lesser metatarsal sesamoids are one of the most common accessory bones of the foot and are most commonly seen at the fifth metatarsophalangeal joint. They are rarely seen in other metatarsophalangeal joints. In the literature, there are reports of solitary accessory sesamoid bones seen at lesser metatarsophalangeal joints. We report the case of a 68-year-old woman with lesser metatarsal sesamoids accompanying all of the metatarsophalangeal joints.
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Aper, Rhonda L., Charles L. Saltzman, and Thomas D. Brown. "The Effect of Hallux Sesamoid Resection on the Effective Moment of the Flexor Hallucis Brevis." Foot & Ankle International 15, no. 9 (September 1994): 462–70. http://dx.doi.org/10.1177/107110079401500902.
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In this cadaver study, the functional significance of the hallux sesamoid bones was quantified by measuring the effective tendon moment arm (ETMA) of the flexor hallucis brevis (FHB) force. (The ETMA differs from the anatomic tendon moment arm in that ETMAs are determined by the experimentally measured moment of the tendon force, rather than by the actual location and orientation of the tendon pull in the joint.) The intact case was compared with three levels of progressive sesamoid resection: distal half of the medial sesamoid excised, entire medial sesamoid excised, and both the medial and lateral sesamoids excised. Five dorsiflexion angles of the metatarsophalangeal joint were tested, ranging from −10° to 50°. A known active load was applied to the FHB muscle of fresh frozen cadaver specimens while the corresponding resisting forces from three orthogonally mounted transducers were being recorded. Results showed that the ETMAs decreased significantly ( P < .05) only with the excision of both sesamoids. The percent decrease in ETMA was smallest at dorsiflexion angles of −10° and 15° (4.3% and 2.4%, respectively) and largest at dorsiflexion angles of 25°, 35°, and 50° (29.2%, 22.4%, and 26.7%, respectively). The clinical significance of the results is that distal hemiresection of the medial sesamoid or full medial sesamoid excision is unlikely to appreciably compromise the effective mechanical advantage of the FHB muscle. However, this mechanical advantage may be profoundly diminished by excision of both hallux sesamoids.
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Richardson, E. Greer. "Injuries to the Hallucal Sesamoids in the Athlete." Foot & Ankle 7, no. 4 (February 1987): 229–44. http://dx.doi.org/10.1177/107110078700700405.
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The sesamoids of the great toe, which are small and seemingly insignificant bones, can be the site of disabling pathology for the athlete. Sesamoiditis, osteochondritis, partite sesamoids with stress fractures, displaced fractures, and osteomyelitis have all been reported in the athlete. Bursitis beneath the tibial sesmoid and flexor hallucis brevis tendonitis also occur in the athlete and may be confused with sesamoid injury. Excision of the involved bone is the recommended treatment for displaced fractures and for less severe conditions such as sesamoiditis, osteochondritis, and nondisplaced fractures, if conservative management fails to relieve symptoms.
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Talbot, Kyle D., and Charles L. Saltzman. "Assessing Sesamoid Subluxation: How Good Is the AP Radiograph?" Foot & Ankle International 19, no. 8 (August 1998): 547–54. http://dx.doi.org/10.1177/107110079801900808.
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Subluxation of the metatarsosesamoid joints frequently occurs with the development of hallux valgus deformity, and the restoration of a normal metatarsosesamoid articulation has been proposed as essential for achieving a biomechanically sound operative result. The position of the sesamoid bones on the AP radiograph is used often to assess the pre- and postoperative relationship between the hallucal sesamoids and the metatarsal sulci. We evaluated the validity of this approach. Thirty subjects with hallux valgus and 30 control subjects participated in this study by undergoing both AP and tangential weightbearing radiographs. The sesamoid station on the AP radiographs was compared with the position of the sesamoids on tangential radiographs, using a new continuous measure to estimate subluxation. In approximately half of the cases, we found a difference between the apparent sesamoid station on the AP radiograph and the true position on the tangential one. Increased metatarsal rotation was associated with misclassification of the sesamoid station on the AP radiograph. We conclude that the standard method for measuring the sesamoid station on the AP radiograph is not valid. Surgeons wishing to evaluate the metatarsosesamoid joint should obtain weightbearing tangential radiographs.
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Özkoç, Gürkan, Sercan Akpinar, Metin Özalay, Murat Ali Hersekli, Ayşin Pourbagher, Fazilet Kayaselçuk, and Reha N. Tandogan. "Hallucal Sesamoid Osteonecrosis." Journal of the American Podiatric Medical Association 95, no. 3 (May 1, 2005): 277–80. http://dx.doi.org/10.7547/0950277.
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Four cases of osteonecrosis of hallucal sesamoids are reported here. Surgical excision of necrotic sesamoid tissue yielded satisfactory results, with the patients reporting no residual pain. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistent forefoot pain. (J Am Podiatr Med Assoc 95(3): 277–280, 2005)
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Cake, M. A., and R. A. Read. "Canine and Human Sesamoid Disease." Veterinary and Comparative Orthopaedics and Traumatology 08, no. 02 (1995): 70–75. http://dx.doi.org/10.1055/s-0038-1632432.
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Sesamoid disease is an important cause of lameness in young, large breed dogs, primarily Rottweilers. The patho genesis of the condition is unknown, although trauma does not appear to be the primary cause. Histological findings of bone necrosis suggest that vascular compromise may be involved. Canine sesamoid disease may therefore be related to idiopathic osteonecrosis of the human hallux sesamoids.
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Tzatzairis, Themistoklis, Jannis V. Papathanasiou, Athanasios Ververidis, Ioannis Kazakos, Georgios Drosos, and Konstantinos Tilkeridis. "Oblong Sesamoid Bone Appearance into the Nuchal Ligament. A Case Report." Folia Medica 60, no. 1 (March 1, 2018): 175–79. http://dx.doi.org/10.1515/folmed-2017-0079.
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Abstract Radio-opaque formations behind the spinous processes of the cervical spine are really rare. They were described in 1929 for the first time. Sesamoid ossicles are found close to a bone or a joint and are usually small. Some sesamoids form part of normal human anatomy, while others are normal anatomical variants. We report a case of a 73-year-old Caucasian male who visited the outpatient clinic complaining about chronic cervical pain. An oblong sesamoid accidentally discovered during routine anteroposterior (AP) and lateral x-ray, within the nuchal ligament (NL) at the C3-C6 spinous processes level. A cervical MRI scan was performed and the result showed ‘fabella nuchae’. This type of sesamoids are rarely symptomatic, but it should be differentially diagnosed anyway. We review its morphology, the mechanical factors of the region acting throughout life and last, but not least, the differential diagnosis.
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Batta, Nafisa Shakir, Ankur Gupta, and Vikas Batra. "Imaging Findings of Bilateral Medial Hallucal Sesamoid Insufficiency in a Marathon Runner." Indian Journal of Musculoskeletal Radiology 1 (August 18, 2019): 57–60. http://dx.doi.org/10.25259/ijmsr_6_2019.
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The absence of hallucal sesamoids is an uncommon and incidental entity, bilateral absence is rare, and few cases of symptomatic patients have been reported in literature. Most patients present with metatarsalgia limited to plantar aspect of the great toe, with aggravation of pain on walking and relief at rest. We present a unique case of ipsilateral symptomatic hypoplastic medial hallucal sesamoid and asymptomatic absence of medial sesamoid at the contralateral foot.
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Durrant, Michael, and Tucker McElroy. "Radiographic Image Distortion Between the Distal Edge of the First Metatarsal and the Tibial Sesamoid." Journal of the American Podiatric Medical Association 100, no. 1 (January 1, 2010): 1–9. http://dx.doi.org/10.7547/1000001.
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Background: After failing to statistically confirm a perceived pattern noted on radiographs that the sesamoids were proximally positioned in patients with hallux limitus compared with a control population without evidence of the deformity, the probable causes of this failure were examined. Measurement error was briefly considered but rejected owing to the careful manner in which the measurements were taken. The most plausible explanations were that the observations were incorrect and that the radiographs, which were retrospectively analyzed, were taken in a manner that distorted the spatial relationships between the metatarsal and the tibial sesamoid to a point that the results did not reflect reality. Methods: This study examines potential difficulties in obtaining consistently reliable radiographic data regarding the spatial relationships of the metatarsal and the tibial sesamoid and establishes guidelines to minimize experimental error. Criteria for measuring metatarsal sesamoidal distances to the radiographic plate are established, along with application of the criteria to a control population. The principle of radiographic image distortion as it relates to these objects is presented, and, based on a predetermined range of radiographic angles, radiographic image distortion is calculated for the metatarsal head and the tibial sesamoid separately. Results: By using accepted trigonometric principles, a mathematical model is developed that makes it possible to collectively quantify image shift between the two objects. Conclusions: Criteria are established that, if followed, should minimize image distortion when it is important to measure metatarsal sesamoidal distances. (J Am Podiatr Med Assoc 100(1): 1–9, 2010)
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Alshouli, Mohammed T., Albert Lin, and Anish Raj Kadakia. "Simultaneous First Metatarsophalangeal Joint Arthrodesis and Sesamoidectomy With a Single Dorsomedial Incision." Foot & Ankle Specialist 7, no. 5 (August 19, 2014): 403–8. http://dx.doi.org/10.1177/1938640014545217.
Full textAbstract:
First metatarsophalangeal (MTP) arthrodesis is a well-accepted procedure for the treatment of end-stage hallux rigidus. Despite the excellent and predictable clinical results, the procedure does not address the metatarso-sesamoid joint complex. There has been one case report of arthritis of the metatarsal sesamoid joint as uncommon cause of post–arthrodesis hallux pain. Additionally, we have noted this complication in our practice as well despite the paucity of reported cases in the published literature. Resection of either the tibial or fibular sesamoid is an acceptable treatment for recalcitrant sesamoid pain; however, resection of both the tibial and fibular sesamoids as would be required for arthritic changes is not encouraged to prevent the risk of a cock-up toe deformity. Arthrodesis of the first MTP joint eliminates the possibility of this complication. Resection of the sesamoids following a first MTP fusion requires a separate incision with additional morbidity and risk to the medial plantar digital nerve. This second surgical intervention is not without morbidity and carries additional cast to the patient, which can be avoided if the pathology is appropriately identified preoperatively. We describe the surgical indications and novel technique for a first MTP arthrodesis and total sesamoid resection through a standard dorsomedial incision. The approach adds minimal surgical time and morbidity and eliminates the source of plantar first MTP pain that is present in a cohort of patients with hallux rigidus. Levels of Evidence: Level IV, Case Series
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Mizumoto, Kanoko, Tadashi Kimura, Makoto Kubota, and Mitsuru Saito. "Dislocation of the first metatarsophalangeal joint concomitant with Lisfranc joint dislocation in a 45-year-old man." BMJ Case Reports 14, no. 6 (June 2021): e243004. http://dx.doi.org/10.1136/bcr-2021-243004.
Full textAbstract:
A 45-year-old man presented with severe pinch-point crush injury to his left foot. Plain radiographs revealed dislocation of the first metatarsophalangeal joint and dorsolateral dislocation of the basal phalanx and sesamoids. The first tarsometatarsal joint was subluxed in the plantar direction and the second to fourth tarsometatarsal joints were subluxed dorsally. The sesamoids were displaced dorsolateral to the metatarsal head. There was a longitudinal tear of the joint capsule at the medial margin of the medial sesamoid, which was sutured together with the abductor hallucis tendon and collateral ligament. The Lisfranc and dorsal ligaments in the tarsometatarsal joint were torn and repaired after reduction and fixed with a plate. One year after surgery, there was contracture of the first metatarsophalangeal joint, but the patient had no pain and was able to run.
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Hood, Christopher R., Stephanie Eldridge, Matthew Tran, and Jason R. Miller. "The Rare Lesser Metatarsal Bipartite Sesamoid – A Case Report and Literature Review." Journal of the American Podiatric Medical Association 106, sp1 (January 1, 2016): 8. http://dx.doi.org/10.7547/8750-7315-2016.1.hood.
Full textAbstract:
INTRODUCTION AND OBJECTIVES: There are several various accessory ossicles and sesamoid bones that can be seen throughout the foot and ankle, with reported incidence of 21.2% and 9.6%, respectively. Accessory ossicles and sesamoid bones usually remain asymptomatic until an inciting event (trauma, overuse) occurs and can then cause pain or degenerative changes. They can also be found in routine imaging. One of these confusing findings are lesser metatarsal sesamoids, which are a rare occurrence. Here radiographically we demonstrate the first such case of a fifth metatarsal bipartite sesamoid. METHODS: A 31-year old female presented to the senior authors office for evaluation of the right foot after a motor vehicle accident (MVA). She was told she sustained a foot fracture at an outside emergency department. Her case was reviewed for presentation. RESULTS: Physical exam did not elicit any pain to the forefoot as all symptoms were in the patients ankle. The initial radiograph was reviewed which revealed a bipartite sesamoid of the fifth metatarsal. No pedal fractures to the foot or ankle were appreciatd. MRI was ordered and confirmed this diagnosis with no active pathology to the forefoot. CONCLUSIONS: number one at 7.6% and foot and ankle at 51.4%, respectively. One study found that initial emergency room diagnosis and final foot and ankle outpatient clinic diagnosis did not match in 21.4% of patients evaluated. Lesser metatarsal sesamoids are more common in the 2nd and 5th metatarsal and overall range between 0.2–15%. However, no literature to the authors knowledge exists demonstrating a bipartite lesser sesamoid, and more specifically to 5th metatarsal.
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Conti, Matthew S., Joseph F. Willett, Jonathan H. Garfinkel, Mark C. Miller, Stephen V. Costigliola, Andrew J. Elliott, Stephen F. Conti, and Scott J. Ellis. "Effect of the Modified Lapidus Procedure on Pronation of the First Ray in Hallux Valgus." Foot & Ankle International 41, no. 2 (October 16, 2019): 125–32. http://dx.doi.org/10.1177/1071100719883325.
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Background: Hallux valgus (HV) is a triplanar deformity of the first ray including pronation of the first metatarsal with subluxation of the sesamoids. The purpose of this study was to investigate if a first tarsometatarsal fusion (modified Lapidus technique), without preoperative knowledge of pronation measured on weightbearing computed tomographic (CT) scans, changed pronation of the first metatarsal and determine if reduction of the sesamoids was correlated with changes in first metatarsal pronation. Methods: Thirty-one feet in 31 patients with HV who underwent a modified Lapidus procedure had preoperative and at least 5-month postoperative weightbearing CT scans and radiographs. Differences in preoperative and postoperative pronation of the first metatarsal using a 3-dimensional computer-aided design, HV angle, and intermetatarsal angle (IMA) were calculated using Wilcoxon signed-rank tests. After dividing patients into groups based on sesamoid station, Kruskal-Wallis H tests were used to compare first metatarsal pronation between the groups. Results: The mean preoperative and postoperative pronation of the first metatarsal was 29.0 degrees (range 15.8-51.1, SD 8.7) and 20.2 degrees (range 10.4-32.6, SD 5.4), respectively, which was a mean change in pronation of the first ray of −8.8 degrees ( P < .001). There was no difference in pronation of the first ray when stratified by postoperative sesamoid position ( P > .250). The average preoperative and postoperative IMA was 16.7 degrees (SD 3.2) and 8.8 degrees (SD 2.8), which demonstrated a significant change ( P < .001). Conclusions: The modified Lapidus procedure was an effective tool to change pronation of the first ray. Reduction of the sesamoids was not associated with postoperative first metatarsal pronation. Level of Evidence: Level IV, case series.
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Koblik, P. D., J. G. Whitehair, P. H. Kass, C. Bradley, and K. G. Mathews. "Fragmented palmar metacarpophalangeal sesamoids in dogs: a long-term evaluation." Veterinary and Comparative Orthopaedics and Traumatology 14, no. 01 (2001): 7–14. http://dx.doi.org/10.1055/s-0038-1632666.
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SummaryLong-term clinical and radiographicresponse to surgical and conservativemanagement of 22 dogs with fragmentedsesamoids was evaluated. Mean follow-up was 3.6 years (range = 3 monthsto 11.0 years).Initial (retrospective) and follow-up(prospective) radiographs of the affectedpalmar sesamoids and associatedmetacarpophalangeal joints were evaluatedusing a graded scoring system. A lameness evaluation and physicalexamination were performed at followupin a blinded manner. In addition,owners were asked to complete a questionnaireregarding their pet’s thoraciclimb lameness.There was not any difference betweengroups (sesamoidectomy, conservativemanagement, incidental finding)in age at onset, duration of lamenessprior to therapy, body weight at treatment, time to follow-up, number ofaffected joints, nor owner perceptionsof whether they thought the lamenessimproved, resolved, or recurred, andwhether or not they were pleased withthe outcome.Sesamoid fragmentation treated bysesamoidectomy resulted in significantlygreater progression of radiographicchanges that were consistentwith degenerative joint disease.Chronic lameness resolved or improvedto the point of owner satisfactionwith conservative therapy in most cases. Continued lameness, or recurrent,although improved lameness associatedwith heavy activity, occurred followingsurgical extirpation of the affectedsesamoids in many cases. Given thesefindings, a more conservative approachto the treatment of chronic lamenessassociated with sesamoid fragmentationmay be warranted.Long-term clinical and radiographic response to surgical and conservative management of 22 dogs with fragmented sesamoids was evaluated. Mean follow-up was 3.6 years. Sesamoid fragmentation treated by sesamoidectomy resulted in significantly greater progression of radiographic changes that were consistent with degenerative joint disease. Chronic lameness resolved or improved to the point of owner satisfaction with conservative therapy in most cases. Continued or recurrent lameness was common following sesamoidectomy. Conservative therapy should be attempted prior to sesamoidectomy for dogs with chronic lameness associated with palmar metacarpophalangeal sesamoid fragmentation.
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Danna, Natalie, James Rizkalla, and James Brodsky. "Technique." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0019. http://dx.doi.org/10.1177/2473011418s00198.
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Category: Midfoot/Forefoot Introduction/Purpose: Sesamoidectomy is most often indicated for sesamoid fractures. The procedure may also be a useful option for cases of recalcitrant sesamoiditis, osteochondritis dissecans, and osteoarthritis. In instances of concomitant arthritis of the first metatarsophalangeal joint and the sesamoids, sesamoidectomy may be performed in tandem with first metatarsophalangeal joint fusion. This carries the additional benefit of harvesting bone graft from the excised sesamoid to include in the fusion construct. Though sesamoidectomy is commonly performed through a medial or plantar approach, neither of these approaches are suited to fusion of the first metatarsophalangeal joint. Sesamoidectomy can be performed effectively through a dorsal approach and is the preferred technique when performed in conjunction with first metatarsophalangeal joint fusion. Methods: A dorsal midline incision is made over the first metatarsophalangeal joint. Care is taken to protect the extensor hallucis longus tendon while dissection proceeds to the joint capsule. The capsule is incised and released so that the first metatarsophalangeal joint can be sufficiently mobilized. Next, the opposing joint surfaces are prepared, increasing the mobility of the joint and exposure of surrounding structures. Results: (technique, continued) A sharp retractor is used to elevate the metatarsal head. Hyperflexion of the metatarsophalangeal joint may increase visualization of the sesamoids. A fresh knife is used to tease the sesamoid away from the flexor hallucis longus tendon, beginning at one edge of the sesamoid. The bone is carefully elevated off the tendon while dissection proceeds around the perimeter. Once the sesamoid has been freed and excised, the tendon is examined for injury. The excised sesamoid can then be cleared of soft tissue and cartilage and morselized for bone graft. Conclusion: The dorsal approach is effective for sesamoidectomy and efficient when performed as an adjunct to first metatarsophalangeal joint fusion.
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Judge, MS, S. LaPointe, GV Yu, JE Shook, and RP Taylor. "The effect of hallux abducto valgus surgery on the sesamoid apparatus position." Journal of the American Podiatric Medical Association 89, no. 11 (November 1, 1999): 551–59. http://dx.doi.org/10.7547/87507315-89-11-551.
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A new parameter, the tibial sesamoid-second metatarsal distance, was established to determine whether the sesamoids move in relation to the foot in hallux abducto valgus surgery. The reliability of the tibial sesamoid-second metatarsal distance was assessed and shown to be excellent. Seventy-five feet underwent surgical correction of hallux abducto valgus. Four radiographic parameters--the intermetatarsal angle, the hallux abductus angle, the tibial sesamoid position, and the tibial sesamoid-second metatarsal distance--were measured before and after surgery. The hallux abductus angle, intermetatarsal angle, and tibial sesamoid position were all significantly reduced following surgery. The tibial sesamoid-second metatarsal distance was not affected by hallux abducto valgus correction. Thus the correction in sesamoid position gained with hallux abducto valgus correction is a direct result of lateral translocation of the metatarsal head, with no contribution from change in position of the sesamoid apparatus relative to the foot.
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Jones, Jeanine L., and James M. Losito. "Tibial Sesamoid Fracture in a Softball Player." Journal of the American Podiatric Medical Association 97, no. 1 (January 1, 2007): 85–88. http://dx.doi.org/10.7547/0970085.
Full textAbstract:
A single case of a tibial sesamoid fracture in a softball player is reported here. A review of the literature confirms that this is an unusual and difficult problem to treat in the athletic population given the significant loads placed on the sesamoids during athletic activity. In the case presented, conservative care was not effective, and the athlete underwent surgical excision of the fractured sesamoid. With use of a postoperative orthosis and cleat modification, surgical management was successful and allowed the athlete to return to her athletic endeavors without restrictions in 8 weeks. (J Am Podiatr Med Assoc 97(1): 85–88, 2007)
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Saxby, Terence, Robert M. Vandemark, and Reginald L. Hall. "Coalition of the Hallux Sesamoids: A Case Report." Foot & Ankle 13, no. 6 (July 1992): 355–58. http://dx.doi.org/10.1177/107110079201300612.
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Multiple variations in partition of the hallux sesamoids have been described; however, to our knowledge, a coalition of the hallux sesamoids has never been presented. A case of coalition of the hallux sesamoids is presented and the literature is reviewed with respect to the possible significance of this anomaly.
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Pretterklieber, Michael L., and Axel Wanivenhaus. "The Arterial Supply of the Sesamoid Bones of the Hallux: The Course and Source of the Nutrient Arteries as an Anatomical Basis for Surgical Approaches to the Great Toe." Foot & Ankle 13, no. 1 (January 1992): 27–31. http://dx.doi.org/10.1177/107110079201300105.
Full textAbstract:
The arterial supply of the hallux sesamoids was studied in 29 human feet by anatomical dissection. Eight of them underwent radiographic analysis prior to dissection. The sesamoid arteries branch off from the digital plantar arteries of the hallux, which, in turn, are derived from the medial plantar artery and the plantar arch (type A), the plantar arch (type B), or the medial plantar artery (type C). The respective frequencies of types A, B, and C were 52%, 24%, and 24%. The number of sesamoid arteries varied from one (55%) to three (10%) and the number increased with the size of the sesamoid bones. Anatomical knowledge of the course and distribution of these vessels may be of great help to the orthopedist in the understanding of the pathogenesis of avascular necrosis and may provide insight into several technical aspects regarding surgery of the hallux.
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Biedert, Roland, and Beat Hintermann. "Stress Fractures of the Medial Great Toe Sesamoids in Athletes." Foot & Ankle International 24, no. 2 (February 2003): 137–41. http://dx.doi.org/10.1177/107110070302400207.
Full textAbstract:
The purpose of this study was to determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a long jumper. Some swelling to the forefoot and activity-related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plain X-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occur more often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended.
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Hardt, Marcelo Rassweiler, Samuel Machado, Andre Bergamaschi Demore, Antônio Kim, Leandro Marcantonio Camargo, and Carolina Claudino Barbosa. "Epidemiological profile of sesamoid disorders of the first metatarsophalangeal joint." Scientific Journal of the Foot & Ankle 12, no. 2 (June 30, 2018): 102–5. http://dx.doi.org/10.30795/scijfootankle.2018.v12.758.
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Objective: The objective of this study is to describe the epidemiological characteristics of patients with sesamoid disorders in a sample of patients treated in the Brazilian public health system. Methods: A retrospective study was performed by reviewing the electronic charts of foot and ankle outpatient consultations over the past 5 years, analysing variables such as sex, age, occupation, ethnicity, participation in sports, laterality, and affected sesamoid (medial or lateral). Results: Abnormalities in hallucal sesamoids occur more frequently in women (63/108), during the third decade of life (56/108), and in the medial sesamoid (74/108); 65.7% of the sample with these abnormalities participated in physical activity regularly. No significant relationship was observed with laterality or occupation. Conclusion: The most commonly affected patients were females, with a mean age of 23.7 years, who participated in physical activity frequently; the right side and medial sesamoid bone were the most commonly affected sites.
Level of Evidence II; Prospective Study.
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Mitgutsch, Christian, Michael K. Richardson, Rafael Jiménez, José E. Martin, Peter Kondrashov, Merijn A. G. de Bakker, and Marcelo R. Sánchez-Villagra. "Circumventing the polydactyly ‘constraint’: the mole's ‘thumb’." Biology Letters 8, no. 1 (July 13, 2011): 74–77. http://dx.doi.org/10.1098/rsbl.2011.0494.
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Talpid moles across all northern continents exhibit a remarkably large, sickle-like radial sesamoid bone anterior to their five digits, always coupled with a smaller tibial sesamoid bone. A possible developmental mechanism behind this phenomenon was revealed using molecular markers during limb development in the Iberian mole ( Talpa occidentalis ) and a shrew ( Cryptotis parva ), as shrews represent the closest relatives of moles but do not show these conspicuous elements. The mole's radial sesamoid develops later than true digits, as shown by Sox9 , and extends into the digit area, developing in relation to an Msx2 -domain at the anterior border of the digital plate. Fgf8 expression, marking the apical ectodermal ridge, is comparable in both species. Developmental peculiarities facilitated the inclusion of the mole's radial sesamoid into the digit series; talpid moles circumvent the almost universal pentadactyly constraint by recruiting wrist sesamoids into their digital region using a novel developmental pathway and timing.
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Prieskorn, David, Stan Graves, Michael Yen, Ray John, and Schultz Randy. "Integrity of the First Metatarsophalangeal Joint: A Biomechanical Analysis." Foot & Ankle International 16, no. 6 (June 1995): 357–62. http://dx.doi.org/10.1177/107110079501600608.
Full textAbstract:
Five fresh-frozen cadaver feet obtained from traumatic amputations were tested during hyperdorsiflexion stress of the first metatarsophalangeal joint. Three different types of injury were observed: (1) rupture of the capsule proximal to the sesamoids, (2) rupture of the plantar plate distal to the sesamoids, and (3) rupture of the capsular structures medially, allowing a lateral swing of the sesamoids around the metatarsal head. Incomplete dislocation can be associated with significant damage to the plantar plate and other soft tissues of the foot.
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Conti, Stephen F., Audrey Clarke, Matthew S. Conti, Scott J. Ellis, Mark C. Miller, and Amr A. Fadle. "Crista Volume Measured from 3D Reconstructions of Weightbearing CT Scans Shows a Relationship to Sesamoid Station." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0017. http://dx.doi.org/10.1177/2473011420s00172.
Full textAbstract:
Category: Bunion Introduction/Purpose: The progression of hallux valgus (HV) deformities results in dislocation of the sesamoids from their position (station) under the plantar surface of the distal first metatarsal. With this dislocation, the crista separating the two sesamoids erodes as the contact of the medial sesamoid with the crista applies pressure with weightbearing. Recently, three dimensional (3D) reconstructions of the metatarsals and first phalanx have demonstrated a means to find a consistently quantify first metatarsal pronation. These same reconstructions can also produce a reliable technique to compute the volumes of the bones involved. The purpose of the current investigation is to examine the relationship of the volume of the crista to pronation and to sesamoid station. Methods: Eleven HV patients and five normal subjects with weightbearing or weightbearing equivalent CT (WBCT) imaging were randomly selected from the senior author’s patients. Pronation was quantified on WBCT scans using 3D reconstructions as described by Campbell et al. (FAI 2018). Crista volume was determined using a line drawn to connect the nadir of each sulcus on either side of the intersesamoidal crista in each slice of the WBCT image (Figure 1). Sesamoid station was also quantified on WBCT scans using the established four point categorization. A linear regression was performed to determine if the volume of the crista was associated with the pronation angle. The sesamoid station was simplified into two categories - mild medial sesamoid subluxation (less than 50% of the medial sesamoid was lateral to the nadir of the crista) and severe medial sesamoid subluxation - and crista volume between these two groups was compared using a t-test. Results: The regression of crista volume against first metatarsal pronation angle did not show statistical significance (P=0.94, r2=0.03). The mean crista volume in the mild medial sesamoid subluxation group was 156(+-47, range 72 - 231)mm3. The mean crista volume in severe medial sesamoid subluxation was 95 (SD 39, range 35 - 160) mm3. The t-test using simplified sesamoid station to compare crista volumes found that the mean crista volume in the mild medial sesamoid subluxation group was statistically significantly greater the than the mean crista volume in the severe sesamoid subluxation group (P=0.01). Conclusion: In HV, it has been hypothesized that the medial sesamoid erodes the crista resulting in arthritis. This is often overlooked as a source of pain in these patients. Our study found that pronation of the first metatarsal was not correlated with crista volume suggesting that pronation does not affect erosion of the crista. Instead, our results are the first to demonstrate that medial sesamoid subluxation as determined from sesamoid station results in erosion of the crista. This supports the hypothesis that sesamoid subluxation, arthritis, and crista erosion are important components of the HV deformity.
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Wuelker, N., and C. J. Wirth. "The great toe sesamoids." Foot and Ankle Surgery 2, no. 3 (January 1996): 167–74. http://dx.doi.org/10.1046/j.1460-9584.1996.00021.x.
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Anwar, R., S. N. Anjum, and J. E. Nicholl. "Sesamoids of the foot." Current Orthopaedics 19, no. 1 (February 2005): 40–48. http://dx.doi.org/10.1016/j.cuor.2005.01.001.
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Carroll, John J., William D. McClain, and Julia A. V. Nuelle. "Treatment of a Subacute Locked Thumb Metacarpophalangeal Joint with Sesamoid Entrapment." Case Reports in Orthopedics 2019 (March 24, 2019): 1–5. http://dx.doi.org/10.1155/2019/2136540.
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Introduction. Locked thumb metacarpophalangeal (MCP) joints due to entrapped radial sesamoids are rare injuries that commonly require open reduction, especially when the injury is delayed in presentation. Case Presentation. We present a case of a 24-year-old female with a subacute thumb MCP joint subluxation due to an incarcerated radial sesamoid. She underwent successful closed reduction but had persistent pain and difficulty gripping large objects necessitating eventual open volar plate repair despite therapy. She was able to achieve full motion, with little pain and disability, after undergoing delayed volar plate repair. Discussion. Delayed volar plate repair may be considered for those patients who fail to improve with conservative management and occupational therapy after a successful closed reduction for thumb MCP joint subluxation due to an incarcerated radial sesamoid.
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Ergen, Emre, Özgür Yılmaz, Bünyamin Arı, Erkay Nacar, Ayla Özaydoğdu Çimen, Kadir Ertem, and Okan Aslantürk. "Prevalence of metacarpophalangeal sesamoid bones of the hand in Turkish population." Joint Diseases and Related Surgery 32, no. 2 (June 11, 2021): 391–96. http://dx.doi.org/10.52312/jdrs.2021.79.
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Objectives: This study aims to investigate the prevalence and location of the metacarpophalangeal (MCP) sesamoid bones using computed tomography (CT) images. Patients and methods: A total of 767 hands of 735 patients (503 males, 232 females; mean age: 36.9±17.0 years; range, 18 to 105 years) obtained from picture archiving and communication system were retrospectively analyzed between January 2016 and December 2019. The sesamoid bones of MCP joints I, II, III, IV, and V were recorded. Data including age, sex, side, number, pathologies, and location of the sesamoid bones were recorded. Results: The prevalence of sesamoid bones was found to be 100%, 37.61%, 1.17%, 0.5%, and 80% in MCP I, II, III, IV, and V, respectively. There was no significant correlation between the sex of the patient and presence of sesamoid bone at MCP II or MCP V (p>0.970 and p=0.176, respectively). The presence of sesamoid bone at MCP II was statistically significantly correlated with the presence of sesamoid bone at MCP V (p<0.001). There was no statistically significant difference in the side and sesamoid prevalence in the remaining 703 patients (p>0.05). Conclusion: The prevalence of MCP V sesamoid bone is higher than previous studies from our country. The CT of hand can be used to determine sesamoid fractures and degenerative conditions of sesamoids.
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K. Sharma, Praveen, Govindarajan Rajendran, Naveen Kumar Govindaraju, Prashant Moorthy, Karthik Krishna Ramakrishnan, Meyyappan Meenakshi Soma Sundaram, Sneha Yarlagadda, et al. "Prevalence of Sesamoids and Accessory ossicles of the Foot: A Radiographic study of the Indian population and a literature review." Journal of University of Shanghai for Science and Technology 23, no. 09 (September 10, 2021): 340–60. http://dx.doi.org/10.51201/jusst/21/09567.
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The prevalence of accessory ossicles and sesamoids is widely variable.[1,4,5] These bones are normal variants and remain asymptomatic, usually overlooked or misdiagnosed.[1,6] These ossicles and sesamoids are involved in various diseases, including fractures, dislocations, degenerative changes. Others include osteonecrosis, osteoarthritis, osteochondral lesion, avascular necrosis, and impingement syndromes.
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Chen, Jie, Eugene Stautberg, David Spak, Gregory Schneider, and Vinod Panchbhavi. "The corrective ability of the double chevron and Akin osteotomies on medial sesamoid position in Hallux Valgus deformity." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000131.
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Category: Bunion Introduction/Purpose: Recurrence of hallux valgus deformity is a common post-operative complication with rates in the literature ranging from 2.7 – 30%. Lateral displacement of the great toe medial sesamoid is correlated with a high recurrence rate, and failure to reduce sesamoid position has been implicated as a risk factor for recurrence due to an uncorrected deforming force. Sesamoid position has been studied in relation with Scarf osteotomy, but not other corrective osteotomies. The goal of this study is to determine the efficacy of the double chevron and Akin osteotomy in reducing the great toe medial sesamoid. Methods: We retrospectively reviewed all patients in the last five years undergoing hallux valgus correction via the double chevron and Akin osteotomy method with pre-operative and post-operative weight bearing radiographs. We measured sesamoid position pre and post-operatively using the Hardy-Clapham (HC) scale of I-VII with V or greater representing a laterally displaced medial sesamoid. We also measured hallux valgus and inter-metatarsal angles. Measurements were made by three authors in orthopedics and one in radiology. We used intra-class correlation coefficient (ICC) to determine inter-observer agreement and establish reliability. With adequate ICC, we could consider the lead author’s measurements as representative of the group. We examined the percent of hallux valgus cases with displaced sesamoids pre-operatively. Next, we determined how many of those cases did we reduce the sesamoids to grade IV or less. Finally, we performed subgroup analysis for pre-operative HC grades V, VI, and VII to determine correction percentage by severity. Results: There were 49 patients with 53 feet treated with the double chevron and Akin osteotomies for hallux valgus correction. Of these, 39 (73.6%) had significant preoperative lateral displacement of the medial sesamoid characterized by HC grade of V or greater. We corrected 30/39 (77.0%) to a reduced position of HC grade IV or less (p-value 0.048). In sub-analysis, we achieved reduction of the medial sesamoid position in 14/14 feet (100%) with HC grade V, 6/9 feet (66.7%) with HC grade VI, and 10/16 feet (62.5%) with HC grade VII (p-value 0.037). The ICC was 0.91 for pre-operative HC scores and 0.79 for post-operative HC scores. Average pre and post-operative HVA was 29.4° and 8.7°, respectively. Average pre and post-operative IMA was 13° and 5.2° respectively. Conclusion: Our study validates the double chevron and Akin osteotomies as effective in correcting sesamoid position. We achieved correction in 30/39 (77%) cases with initial sesamoid displacement. For mild cases of displacement with HC grade V, sesamoid correction was always achieved, and we were likely to achieve correction in the more severe cases of sesamoid displacement with HC grade VI or VII as well. The technique is also effective at reducing HVA and IMA. We had acceptable inter- observer agreement which supports the reliability of our methods. Future studies should examine recurrence rate following the double chevron and Akin osteotomies prospectively.
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Dean, Robert S., J. Chris Coetzee, Rebecca Stone McGaver, Jacquelyn E. Fritz, and Lawrence J. Nilsson. "Functional Outcome of Sesamoid Excision in Athletes." American Journal of Sports Medicine 48, no. 14 (October 23, 2020): 3603–9. http://dx.doi.org/10.1177/0363546520962518.
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Background: Sesamoid injuries can have a significant effect on the ability of athletes to return to play. The literature shows mixed results with sesamoid excisions and the ability to return to sports. Hypothesis/Purpose: The purpose was to describe patient-reported outcomes and return to sports in athletes after sesamoidectomy with a proper surgical technique and a well-structured rehabilitation protocol. It was hypothesized that sesamoid excision would demonstrate reproducible and encouraging long-term patient outcomes. Study design: Case series; Level of evidence, 4. Methods: All patients from a single surgeon’s practice who underwent sesamoidectomy between January 2006 and September 2015 were identified. Medial sesamoids were excised through a medial approach, and lateral sesamoids were excised through a plantar approach. The plantar structures were adequately repaired after excision. The Foot Function Index–Revised (FFI-R), 12-Item Short Form Health Survey (SF-12), and visual analog scale (VAS) were collected preoperatively and at subsequent follow-up appointments. A patient satisfaction survey and Single Assessment Numeric Evaluation (SANE) questionnaire were also collected. Athletes were defined as those who participated in sports at a high school level or higher. Results: Of the 108 feet that met the inclusion criteria, 26 werelost to follow-up, leaving 82 feet for analysis at a mean 31.3 ± 26.0 months. There were 72 female patients and 10 male patients included in the final analysis, with a mean age of 44.9 ± 20.2 years. There were 54 medial, 18 lateral, and 10 medial and lateral sesamoid excisions. There were 26 competitive athletes with follow-up appointments (dancer, n = 12; pivot sport athlete, n = 8; runner, n = 6). Both the entire study population and the athletes demonstrated a significant improvement in SF-12, SANE, VAS, and FFI-R cumulative at the latest available follow-up ( P < .05). Among the athletes, 80% were able to return to competitive sports at a mean 4.62 ± 1.01 months after surgery. The median satisfaction score among all patients was 97.5%. There was no difference in the success rate between the different etiologies at any of the follow-up intervals. Conclusion: Chronic sesamoid pain is difficult to treat, but this study confirms that with a meticulous surgical technique and a dedicated postoperative rehabilitation program, encouraging patient-reported outcomes can be expected with a minimal risk of complications. Moreover, in the current study, 80% of competitive athletes were able to return to sports at a mean of 4.62 months after surgery.
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Ohtsuka, Kazutaka, Tsukasa Teramoto, Yoshiaki Makino, and Katsuro Iwasaki. "Disorders of the Hallux Sesamoids." Orthopedics & Traumatology 44, no. 2 (1995): 629–34. http://dx.doi.org/10.5035/nishiseisai.44.629.
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Karadaglis, Dimitriois, and David Grace. "Morphology of the hallux sesamoids." Foot and Ankle Surgery 9, no. 3 (January 2003): 165–67. http://dx.doi.org/10.1016/s1268-7731(03)00071-7.
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Bartosiak, Kimberly, and Jeremy J. McCormick. "Avascular Necrosis of the Sesamoids." Foot and Ankle Clinics 24, no. 1 (March 2019): 57–67. http://dx.doi.org/10.1016/j.fcl.2018.09.004.
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Mohler, L. Randall, and Thomas E. Trumble. "DISORDERS OF THE THUMB SESAMOIDS." Hand Clinics 17, no. 2 (May 2001): 291–301. http://dx.doi.org/10.1016/s0749-0712(21)00249-3.
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Connolly, C. M., J. Alsousou, S. Hassan, and N. W. Williams. "Don't avoid the sesamoids: fracture to the ulnar sesamoid of the first metacarpophalangeal joint." Emergency Medicine Journal 25, no. 3 (March 1, 2008): 184. http://dx.doi.org/10.1136/emj.2007.053579.
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Catanese, Dominic, Daniel Popowitz, and Aharon Z. Gladstein. "Measuring Sesamoid Position in Hallux Valgus." Foot & Ankle Specialist 7, no. 6 (July 7, 2014): 457–59. http://dx.doi.org/10.1177/1938640014539804.
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Measuring tibial sesamoid position is an important component of the preoperative radiographic evaluation of hallux valgus as it helps guide the surgeon in surgical selection. Tibial sesamoid position is typically measured on an anteroposterior (AP) radiograph on a scale from 1 to 7 as described by Hardy and Clapham. Some authors have advocated measuring the position on the sesamoid axial view, noting that the AP and axial views often yield different measurements. There is no consensus as to which view is more helpful in guiding the surgeon’s surgical decision. Weightbearing radiographs of 99 feet in patients with a clinical diagnosis of hallux valgus were retrospectively reviewed. Tibial sesamoid position was measured on the AP view using the 7-point scale of Hardy and Clapham. Tibial sesamoid position was also measured on the axial radiograph. Cohen’s kappa statistic was used to assess agreement of measurements obtained on the 2 views. There was poor agreement of the AP and axial views, with a kappa of 0.31. In our analysis of the data, it was determined that the lack of agreement was due mainly to X-rays showing tibial sesamoid positions of 4 and 5. A subgroup analysis of all X-rays with tibial sesamoids in positions other than 4 or 5 showed excellent agreement, with a kappa of 0.95. Anteroposterior and sesamoid axial views of feet with hallux valgus show excellent agreement in patients with the tibial sesamoid in positions other than 4 or 5. If the tibial sesamoid has a position of 4 or 5 on the AP, an axial view may be warranted to further understand the extent of deformity. Levels of Evidence: Diagnostic, Level IV: Case series