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Benslima N, Mniai EM, Kassimi M, Mahi M. Hallucal sesamoiditis on a bipartite sesamoid bone: An uncommon cause of chronic great toe pain. Radiol Case Rep 2023; 18:3357-3360. [PMID: 37502136 PMCID: PMC10371764 DOI: 10.1016/j.radcr.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/29/2023] Open
Abstract
The pathologies and lesions affecting the sesamoid bones of the hallux are uncommon and can be easily overlooked. Among them, sesamoiditis is a relatively rare condition known to cause severe great toe pain; lack of awareness of this particular entity leads to misdiagnosis, delayed treatment, and contributes to significant morbidity. Herein, we present a chronic sesamoiditis case occurring on a medial bipartite sesamoid bone, presenting as chronic great toe pain. The main purpose of this work is to discuss the role of magnetic resonance imaging and X-rays in the diagnosis process. To the best of our knowledge, no cases of great toe sesamoiditis occurring on a bipartite bone in no-athletic patients have yet been reported.
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2
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Lim S, Liem B. First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations. Curr Sports Med Rep 2023; 22:217-223. [PMID: 37294197 DOI: 10.1249/jsr.0000000000001076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT The first metatarsal-phalangeal joint plays a key role for athletes of various disciplines. When an athlete presents for evaluation of pain at this joint, there are several causes that should be considered. The purpose of this article is to review common injuries including turf toe, sand toe, extensor and flexor hallucis longus tendinopathy, sesamoiditis, and metatarsalgia and provide current evidence-based recommendations for diagnosis, management, and return to play considerations. Conditions not specific to athletes like gout and hallux rigidus also are discussed. Mechanism of injury, physical examination, and imaging such as weight-bearing radiographs and point-of-care ultrasound can help with diagnosis. Treatment of many of these injuries begins with nonsurgical management strategies including footwear or activity modification, physical therapy, and select interventions.
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Affiliation(s)
- Sara Lim
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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3
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Thorhauer E, French M, Kimura T, Ledoux WR. A Cadaveric Comparison of the Kinematic and Anatomical Axes and Arthrokinematics of the Metatarsosesamoidal and First Metatarsophalangeal Joints. J Biomech Eng 2023; 145:1148497. [PMID: 36301250 DOI: 10.1115/1.4056060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022]
Abstract
Presently, developments in weightbearing computed tomography and biplanar fluoroscopy technologies offer exciting avenues for investigating normative and pathologic foot function with increasing precision. Still, data quantifying sesamoid bone and proximal phalange motion are currently sparse. To express joint kinematics and compare various clinical cohorts, future studies of first ray motion will necessitate robust coordinate frames that respect the variations in underlying anatomy while also aligning closely with the functional, physiological axes of motion. These activity-dependent functional axes may be represented by a mean helical axis of the joint motion. Our cadaveric study quantified joint kinematics from weightbearing computed tomography scans during simulated toe lift and heel rise tasks. We compared the spatial orientations of the mean finite helical axes of the metatarsosesamoidal and metatarsophalangeal joints to the primary joint axis of two relevant methods for defining metatarsal coordinate frames: inertial axes and fitting of geometric primitives. The resultant kinematics exhibited less crosstalk when using a metatarsal coordinate system based on fitting cylindrical primitives to the bony anatomy compared to using principal component axes. Respective metatarsophalangeal and metatarsosesamoidal arthrokinematic contact paths and instantaneous centers of rotation were similar between activities and agree well with currently published data. This study outlines a methodology for quantitatively assessing the efficacy and utility of various anatomical joint coordinate system definitions. Improvements in our ability to characterize the shape and motion of foot bones in the context of functional tasks will elucidate their biomechanical roles and aid clinicians in refining treatment strategies.
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Affiliation(s)
- Eric Thorhauer
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA 98195; RR&D Center for Limb Loss and Mobility (CLiMB) Veterans Affairs Puget Sound Health Care System, ms 151, 1660 South Columbian Way, Seattle, WA 98108
| | - Mackenzie French
- School of Medicine, Department of Mechanical Engineering, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195
| | - Tadashi Kimura
- Department of Orthopaedic Surgery, School of Medicine, The Jikei University, Minato City, 3 Chome-25-8 Nishishinbashi, Tokyo 105-8461, Japan
| | - William R Ledoux
- Departments of Mechanical Engineering, Orthopaedics & Sports Medicine, University of Washington, Stevens Way, Box 352600, Seattle, WA 98195; RR&D Center for Limb Loss and Mobility (CLiMB) Veterans Affairs Puget Sound Health Care System, ms 151, 1660 South Columbian Way, Seattle, WA 98108
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4
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Le HM, Stracciolini A, Stein CJ, Quinn BJ, Jackson SS. Platelet rich plasma for hallux sesamoid injuries: a case series. PHYSICIAN SPORTSMED 2022; 50:181-184. [PMID: 34346850 DOI: 10.1080/00913847.2021.1964006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. METHODS This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries. RESULTS The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14-128 weeks). The average time out of their primary sport was 48.7 weeks (20-78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6-9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments. CONCLUSION In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.
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Affiliation(s)
- Hung M Le
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Stracciolini
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cynthia J Stein
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bridget J Quinn
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sarah S Jackson
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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5
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Rachakonda A, Kollimarla V, Iyengar KP. Simultaneous medial and lateral hallucal sesamoid fractures in a basketball player mimicking bipartite sesamoid condition. J Clin Orthop Trauma 2022; 26:101802. [PMID: 35256997 PMCID: PMC8897189 DOI: 10.1016/j.jcot.2022.101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 02/04/2023] Open
Abstract
Simultaneous fractures of the medial and lateral hallucal sesamoids from sports injuries are an extremely uncommon occurrences, with only one case reported in a hurdler. We describe an unusual injury in a basketball player resulting in simultaneous fractures of the medial and lateral hallucal sesamoid bones, a presentation, which we believe has not been reported before in the literature. With a growing interest in sports, the frequency of such injuries will undoubtedly rise. We highlight the clinical characteristics, biomechanical mechanism, role of complementary cross-sectional imaging in the diagnosis of hallucal sesamoid fractures. This case report emphasizes the need of high index of suspicion in reaching conclusive diagnosis of such rare injuries to prevent long term complications such as avascular necrosis or non-union and facilitate early return to sporting activities.
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Affiliation(s)
- Akhila Rachakonda
- Medical Student,Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Venkata Kollimarla
- Medical Student,Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
- Corresponding author. Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK.
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6
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Strassberg J, Ahmed A. Pediatric Sports Injuries. Clin Podiatr Med Surg 2022; 39:89-103. [PMID: 34809797 DOI: 10.1016/j.cpm.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recreational sports are more popular, with many athletes involved year-round in multiple sports and on multiple teams. Most athletes do not take proper rest, making them more susceptible to stress-related injuries. There are numerous sports-related injuries in the foot and ankle. These issues can be non-traumatic, due to chronic repetitive stresses, or traumatic. Most of these injuries are managed conservatively, and athletes do well and return to play, while some do better with operative management. This article discusses a few of the sports injuries that are common in the leg, foot, and ankle and the recovery process.
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Affiliation(s)
- Joshua Strassberg
- The Pediatric Orthopedic Center, 218 Ridgedale Avenue, Suite 101, Cedar Knolls, NJ 07927, USA
| | - Aamir Ahmed
- Ankle and Foot Doctors of New Jersey, 225 Millburn Avenue, Suite #104B, Millburn, NJ 07041, USA.
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7
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Shin EH, Kwon WH, Dujela MD, Kim BS. Arthroscopic Synovectomy and Excision of a Sesamoid in the Management of an Atypical Presentation of Avascular Necrosis of Bone: A Case Report. J Foot Ankle Surg 2021; 59:594-597. [PMID: 32354515 DOI: 10.1053/j.jfas.2019.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 02/03/2023]
Abstract
Avascular necrosis of a sesamoid bone is a rare and incompletely understood entity. Furthermore, associated lesions secondary to sesamoid pathology have seldom been described in the literature. We report a case of avascular necrosis of the medial sesamoid, accompanied by severe synovitis of the first metatarsophalangeal joint, that was successfully managed with arthroscopic synovectomy and open excision of the sesamoid.
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Affiliation(s)
- Eun Ho Shin
- Surgeon, Department of Orthopaedic Surgery, Haneul Orthopedics Clinic, Incheon, Korea
| | - Won Hwan Kwon
- Surgeon, Department of Orthopaedic Surgery, Inha University Hospital College of Medicine, Incheon, Korea
| | | | - Bom Soo Kim
- Surgeon, Department of Orthopaedic Surgery, Inha University Hospital College of Medicine, Incheon, Korea; Associate Professor, Department of Orthopaedic Surgery, Inha University Hospital College of Medicine, Incheon, Korea.
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8
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Towler OW, Kaplan FS, Shore EM. The Developmental Phenotype of the Great Toe in Fibrodysplasia Ossificans Progressiva. Front Cell Dev Biol 2020; 8:612853. [PMID: 33364240 PMCID: PMC7753048 DOI: 10.3389/fcell.2020.612853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/16/2020] [Indexed: 12/30/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder in which extensive heterotopic ossification (HO) begins to form during early childhood and progresses throughout life. Although HO does not occur during embryonic development, children who carry the ACVR1R206H mutation that causes most cases of FOP characteristically exhibit malformation of their great toes at birth, indicating that the mutation acts during embryonic development to alter skeletal formation. Despite the high prevalence of the great toe malformation in the FOP population, it has received relatively little attention due to its clinically benign nature. In this study, we examined radiographs from a cohort of 41 FOP patients ranging from 2 months to 48 years of age to provide a detailed analysis of the developmental features, progression, and variability of the great toe malformation of FOP, which include absent skeletal structures, malformed epiphyses, ectopic ossification centers, malformed first metatarsals and phalangeal fusion.
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Affiliation(s)
- O Will Towler
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.,The Center for Research in FOP & Related Disorders, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States
| | - Frederick S Kaplan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.,The Center for Research in FOP & Related Disorders, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Eileen M Shore
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States.,The Center for Research in FOP & Related Disorders, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, United States.,Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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9
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Lombard C, Gillet R, Rauch A, Germain E, Dodin G, Blum A, Teixeira PG. Hallux sesamoid complex imaging: a practical diagnostic approach. Skeletal Radiol 2020; 49:1889-1901. [PMID: 32583133 DOI: 10.1007/s00256-020-03507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 02/02/2023]
Abstract
A wide variety of pathologies can affect the hallux sesamoid complex of the foot, including traumatic, micro traumatic, degenerative, inflammatory, vascular, infectious, and neoplastic conditions. Symptoms are quite nonspecific, mainly related to pain in the plantar surface of the first metatarsal head. In this context, imaging is important for the etiologic diagnosis of hallux sesamoid complex pathology with implications in patient management. The hallux sesamoid complex has a complex anatomy, and pathologic processes of this region are poorly known of radiologists. Besides, some entities such as "sesamoiditis" remain poorly defined in the literature. Schematically, conditions affecting sesamoids will be divided into two major groups: intrinsic anomalies (sesamoid bone being the center of the pathologic process) and extrinsic anomalies (diseases secondarily involving sesamoid bones). Thus, in this article, after a review of anatomical key points and pathologies affecting the hallux sesamoid complex, a practical multimodality approach for the diagnosis of hallux sesamoid pathologies will be proposed.
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Affiliation(s)
- Charles Lombard
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France.
| | - Romain Gillet
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Aymeric Rauch
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Edouard Germain
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Gauthier Dodin
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Alain Blum
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
| | - Pedro Gondim Teixeira
- Service d'imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035, Nancy Cedex, France
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10
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Lee SYS, Tan TJ, Yan YY. Fracture of a Bipartite Medial Hallux Sesamoid Masquerading as a Tripartite Variant: A Case Report and Review of the Literature. J Foot Ankle Surg 2019; 58:980-983. [PMID: 31345761 DOI: 10.1053/j.jfas.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Indexed: 02/03/2023]
Abstract
We report a case of a competitive athlete who complained of chronic pain over the first metatarsal head in the absence of preceding trauma that was exacerbated with forced plantar flexion of the big toe. Initial radiographic findings suggested a tripartite appearance of the medial hallux sesamoid, and the patient was treated as for sesamoiditis. However, persistent symptoms over a period of 12 months necessitated further imaging with magnetic resonance, which confirmed a fracture of the bipartite medial hallux sesamoid. Considering that it is clinically important to differentiate between a tripartite/multipartite hallux sesamoid variant and a fracture of a bipartite hallux sesamoid, an expedient diagnosis is vital to avoiding complications of stress fractures. This can be a diagnostic challenge for the radiologist, emergency physician, and orthopedic surgeon, requiring a high index of suspicion. Accurate and timely diagnosis can be achieved with a clear history, detailed physical examination, and appropriate radiological evaluation.
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Affiliation(s)
- Shu Yi Sonia Lee
- Senior Resident, Department of Radiology, Changi General Hospital, Singapore.
| | - Tien Jin Tan
- Consultant Radiologist, Department of Radiology, Changi General Hospital, Singapore
| | - Yet Yen Yan
- Associate Consultant Radiologist, Department of Radiology, Changi General Hospital, Singapore
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11
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Pearson JM, Moraes LVM, Paul KD, Peng J, Chinnakkannu K, McKissack HM, Shah A. Is Fibular Sesamoidectomy a Viable Option for Sesamoiditis? A Retrospective Study. Cureus 2019; 11:e4939. [PMID: 31431844 PMCID: PMC6695232 DOI: 10.7759/cureus.4939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Pathologic conditions of the sesamoids can be a source of disabling pain for patients, particularly during toe-off. Some underlying causes include osteonecrosis, inflammation, arthritis, and fracture. Nonoperative treatment is the initial standard of care, and has demonstrated satisfactory outcomes overall; however, operative management may be indicated in cases of pain refractory to conservative management. Sesamoidectomy is an uncommon procedure with risk of potential complications, but may be warranted in select cases of failed nonoperative treatment. Methods A retrospective chart review was conducted at one institution from 2009 to 2018. Twelve patients diagnosed with fibular sesamoiditis were treated with sesamoidectomy. Baseline patient demographics as well as postoperative outcomes were recorded. Results All 12 patients underwent fibular sesamoidectomy using the plantar approach following which their symptom (pain) resolved. Average follow-up for this cohort was 35 months. Of the sample, two patients experienced transient neuritis, one patient developed a superficial infection, and one had painful postoperative scarring. Hallux varus deformity was not observed in any patients. Conclusion Fibular sesamoidectomy may be a safe, viable procedure for patients with sesamoiditis who fail conservative measures.
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Affiliation(s)
- Jeffrey M Pearson
- Orthopaedic Surgery, University of Alabama School of Medicine, Birmingham, USA
| | - Leonardo V M Moraes
- Orthopedics, Instituto De Assistência Médica Ao Servidor Público Estadual (IAMPSE), São Paulo, BRA
| | - Kyle D Paul
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Jianguang Peng
- Orthopaedic Surgery, Xuanwu Hospital Capital Medical University, Beijing, CHN
| | | | - Haley M McKissack
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Ashish Shah
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
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12
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Guo S, Yan YY, Lee SSY, Tan TJ. Accessory ossicles of the foot-an imaging conundrum. Emerg Radiol 2019; 26:465-478. [PMID: 30963314 DOI: 10.1007/s10140-019-01688-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
Various anatomical variations can be found in the foot and ankle, including sesamoid bones and accessory ossicles. These are usually incidental findings and remain asymptomatic; however, they may cause complications resulting in painful syndromes or degenerative changes secondary to overuse or trauma. They can also lead to fractures or simulate fractures. These complications are challenging to diagnose on radiographs. Advanced imaging with US, CT, MRI, or Tc-99m bone scan is useful for definitive diagnosis. This study aims to illustrate how imaging modalities can be used to diagnose complications of common sesamoids and accessory ossicles of the ankle and foot (hallux sesamoids, os trigonum, accessory navicular, os supranaviculare, os peroneum, os intermetatarseum, and os calcaneus secundarius) and demonstrate the imaging differences between fractures and their mimics.
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Affiliation(s)
- Shuyi Guo
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Yet Yen Yan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Sonia Shu Yi Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
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13
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Mauler F, Wanivenhaus F, Böni T, Berli M. Nonsurgical Treatment of Osteomyelitis of the Hallux Sesamoids: A Case Series and Literature Review. J Foot Ankle Surg 2017; 56:666-669. [PMID: 28476396 DOI: 10.1053/j.jfas.2017.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to determine the effectiveness of nonsurgical treatment for osteomyelitis of the hallucal sesamoids. Osteomyelitis of the hallucal sesamoids in young and healthy patients is rare and might originate from hematogenous spread or after a puncture wound. In diabetic patients with peripheral neuropathy, it often results from direct contiguous seeding from adjacent ulceration. The superiority of surgical versus nonsurgical therapy is still debated. In our institution, all patients presenting with osteomyelitis of the hallucal sesamoids are first treated nonsurgically but eventually usually require a surgical procedure. We reviewed 18 patients with a clinical and radiologic diagnosis of osteomyelitis of the hallucal sesamoids treated in our institution during a 13-year period (from January 2000 to December 2012). The inclusion criteria were a signal alteration on magnetic resonance imaging or bone lesions on computed tomography or conventional radiographs, combined with a deep ulcer with a positive probe-to-bone test. Nonsurgical therapy consisted of frequent wound treatment, immobilization, offloading in a cast or other orthotic device, and oral antibiotics. Of the 18 patients, 11 had diabetes, 16 had peripheral neuropathy, 11 had peripheral arterial disease, and 5 had immunosuppression. After a period of nonsurgical therapy ranging from 4 weeks to 9 months, 15 of 18 patients required surgical excision, internal resection, or amputation. In this patient population, we no longer consider nonsurgical therapy a viable option. Patients should be advised, before starting nonsurgical treatment, that the therapy will be long and demanding and very often results in a surgical procedure.
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Affiliation(s)
- Flavien Mauler
- Orthopaedic Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Florian Wanivenhaus
- Orthopaedic Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Thomas Böni
- Attending Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Martin Berli
- Attending Surgeon, Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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14
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Zrig M, Othman Y, Bellaaj Z, Koubaa M, Abid A. Dislocation of the First Metatarsophalangeal Joint: A Case Report and Suggested Classification System. J Foot Ankle Surg 2017; 56:643-647. [PMID: 28314638 DOI: 10.1053/j.jfas.2016.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Indexed: 02/03/2023]
Abstract
Dislocation of the first metatarsophalangeal joint is a relatively rare and still poorly known injury. The current classification includes only the dorsal variety of this lesion; thus, as further cases of other varieties are reported, a larger understanding of this entity is required. We report the case of a young male with dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction. The clinical outcome at the 2-year follow-up point is reported. A review of the published data of the variations of this injury reported to date is included, and a new summarizing classification is suggested.
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Affiliation(s)
- Makram Zrig
- Professor of Orthopedic Surgery, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Youssef Othman
- Orthopedic Surgeon, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Zied Bellaaj
- Assistant Associate Professor of Orthopedic Surgery, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mustapha Koubaa
- Professor of Orthopedic Surgery, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Abderrazek Abid
- Professor of Orthopedic Surgery, Head of Department, Department of Orthopaedic and Traumatic Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
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15
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16
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Daddimani RM, Madhavamurthy SK, Jeevannavar SS, Shettar CM. Fracture of the medial tibial sesamoid bone of the foot-case report. J Clin Diagn Res 2015; 9:RD03-4. [PMID: 26023612 PMCID: PMC4437128 DOI: 10.7860/jcdr/2015/12899.5831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/20/2015] [Indexed: 11/24/2022]
Abstract
The sesamoid bone ligament complex of foot contains two sesamoid bones one medial tibial sesamoid and other lateral fibular sesamoid bone, both embedded in the plantar ligament beneath first metatarsal head. The incidence of medial tibial sesamoid bone fracture is rare. Clinically they are often misdiagnosed as soft tissue injuries and often missed. We present a case of fracture medial tibial sesamoid bone in a young athlete who was diagnosed radiologically and treated conservatively with activity restriction and foot wear modification. Our case draws attention to this easily treatable fracture and outlines the investigative modalities in diagnosing this fracture.
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Affiliation(s)
- Ravi Mahalingappa Daddimani
- Assistant Professor, Department of Orthopaedics, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - Srinath Kadagattur Madhavamurthy
- Assistant Professor, Department of Orthopaedics, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - Santosh Somayya Jeevannavar
- Professor, Department of Orthopaedics, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
| | - Chidendra Manohar Shettar
- Professor, Department of Orthopaedics, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
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Turf toe and sesamoiditis: what the radiologist needs to know. Clin Imaging 2014; 39:380-9. [PMID: 25482355 DOI: 10.1016/j.clinimag.2014.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/08/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
Abstract
The first metatarsophalangeal (MTP) joint complex is a critical weight-bearing structure important to biomechanics. An acute dorsiflexion injury, named "turf toe," is common among American football and soccer players. "Sesamoiditis" is a name often given for pain arising from the hallux sesamoids in the absence of acute trauma, and may result from a variety of causes. The first MTP joint complex can also be affected by degenerative or inflammatory arthritis, infarct, and infection. This review article will cover the anatomy and biomechanics of the first MTP joint complex, its patterns of injury and pathology, imaging techniques, and management.
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18
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Abstract
Sports-related injuries of the foot are common and may result in significant morbidity, particularly if inaccurate or delayed diagnosis leads to improper management. While less common than injuries of the ankle, sports-related foot injuries account for 2% to 18% of athletic injuries. Injury may occur as a result of acute trauma or chronic overuse, and high-impact sports that involve running, jumping, or contact place the athlete at higher risk for injury. Accurate and timely diagnosis of injury is the key to proper management, and diagnostic imaging studies often play a critical role in this regard. While radiographs, computerized tomography scans, and ultrasound are useful in the evaluation of the foot, magnetic resonance imaging provides superior tissue contrast as well as the ability to detect stress reaction in bone that precedes discernible fracture line on radiographs, allowing accurate detection of both osseous and soft tissue pathology. This review focuses on imaging of common sports-related injuries of the midfoot and forefoot, including osseous, ligamentous, and tendinous pathology, with emphasis on magnetic resonance imaging diagnosis.
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19
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Forefoot: a basic integrated imaging perspective for radiologists. Clin Imaging 2014; 38:397-409. [PMID: 24746447 DOI: 10.1016/j.clinimag.2014.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/29/2014] [Accepted: 02/20/2014] [Indexed: 02/07/2023]
Abstract
Imaging of the forefoot is increasingly requested for patients with metatarsalgia. Awareness with specific anatomic arrangements exclusive for the forefoot and widely variable pathologic entities associated with metatarsalgia helps the radiologist to tailor a cost-effective imaging approach. This will enable reaching a specific diagnosis as much as possible with subsequent proper patient management. This pictorial review aims to provide basic understanding for the different imaging modalities used in studying the forefoot. After that, certain anatomic arrangements exclusive for the forefoot are discussed. The final section of this review describes the imaging findings of some common forefoot problems.
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