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Stewart S, Kaur P, Tehan P, Molyneux P, Carroll M. The development of recommendations for the assessment and management of sesamoiditis by podiatrists: A Delphi and content validity study. J Foot Ankle Res 2024; 17:e12025. [PMID: 38820171 DOI: 10.1002/jfa2.12025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION Sesamoiditis is a common, and often painful, musculoskeletal pathology frequently encountered by podiatrists. However, there are currently no recommendations to guide podiatrists in the assessment and management of people with sesamoiditis. The aim of this study was to develop consensus-driven clinical recommendations on the assessment and management of people with sesamoiditis. METHODS A four-round online Delphi survey was conducted with a panel of New Zealand and Australian podiatrists. In the first round, panellists answered open-ended questions that were used to create statements. In round two, the panellists scored the statements from 1 to 9 (1 = not at all important, 9 = absolutely essential). Consensus was defined using the RAND/University of California Los Angles Disagreement Index. Panellists were asked to reconsider statements that did not achieve consensus in round three. In the final round, content validity and acceptability of the statements for inclusion in clinical recommendations were determined using content validity ratios and the Content Validity Index (CVI). RESULTS Eighteen panellists completed round one with 16 (89%) completing all four rounds. A total of 118 statements were generated following round one. Following rounds two and three, 78 statements were accepted by panellists as being important, with 62 statements achieving sufficient content validity for inclusion in clinical recommendations. The CVI for these 62 statements was 0.58. These recommendations provide guidance on subjective assessment (pain characteristics/symptomology, activity/sports/training history and medical history) objective assessment (establishing a diagnosis, identifying contributing biomechanical factors, footwear/orthoses, ruling out differential diagnoses) and management (temporary padding/strapping, education, footwear, foot orthoses and when to consider referral). CONCLUSION This consensus exercise has provided a set of consensus-based recommendations for the assessment and management of people with sesamoiditis. In the current absence of research-based evidence in this area, these recommendations are intended to support clinicians. The recommendations may also serve as a basis for future clinical trials evaluating the efficacy of conservative interventions for people with sesamoiditis.
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Affiliation(s)
- Sarah Stewart
- Department of Podiatry, Auckland University of Technology, Auckland, New Zealand
| | - Preeti Kaur
- Auckland Sports Podiatry, Auckland, New Zealand
| | - Peta Tehan
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Prue Molyneux
- Department of Podiatry, Auckland University of Technology, Auckland, New Zealand
| | - Matthew Carroll
- Department of Podiatry, Auckland University of Technology, Auckland, New Zealand
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2
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Vazquez M, Henry S, Parot L, Subhawong T. Paediatric sand toe: radiographic, ultrasound and MRI findings of dorsomedial capsular injury. BMJ Case Rep 2023; 16:e253241. [PMID: 38129088 DOI: 10.1136/bcr-2022-253241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Hyperflexion injury to the metatarsophalangeal joint of the great toe, referred to as sand toe, can cause significant functional impairment. To our knowledge, there have been no radiological descriptions of this injury in the paediatric age group. Here, we report radiographic, sonographic and MRI findings in a male paediatric patient who sustained a sand toe injury, highlighting structural damage to the dorsomedial capsule and medial sagittal band, and discuss sand toe's favourable prognosis with conservative management.
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Affiliation(s)
- Manuel Vazquez
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephen Henry
- Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis Parot
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ty Subhawong
- University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Ivanova V, Todd NW, Yurgelon J. Dance-Related Foot and Ankle Injuries and Pathologies. Clin Podiatr Med Surg 2023; 40:193-207. [PMID: 36368843 DOI: 10.1016/j.cpm.2022.07.013] [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: 11/16/2022]
Abstract
Dancers are highly vulnerable to injuries due to high dynamic overload, extreme positions and motions, and excessive use. Increased load at the forefoot with jumping and high-impact lands can cause sesamoiditis and stress fractures of the metatarsals. Significant plantarflexion can lead to posterior joint impingement and flexor hallucis longus tendonitis, whereas forced dorsiflexion can cause anterior joint impingement. Most pathologies can be diagnosed on physical examination and various imaging modalities. Treatment should be tailored to the dancers' needs and should begin with a course of conservative therapy with immobilization, physical therapy, and activity cessation.
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Affiliation(s)
- Varsha Ivanova
- Kaiser Permanente, 710 Lawrence Expressway, Santa Clara, CA 95051, USA
| | - Nicholas W Todd
- Palo Alto Medical Foundation Mountain View Center, 701 East EL Camino Real, Mountain View, CA 94040, USA
| | - Jesse Yurgelon
- Palo Alto Medical Foundation Mountain View Center, 701 East EL Camino Real, Mountain View, CA 94040, USA.
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Carroll LA, Paulseth S, Martin RL. Forefoot Injuries in Athletes: Integration of the Movement System. Int J Sports Phys Ther 2022; 17:81-89. [PMID: 35024208 PMCID: PMC8720253 DOI: 10.26603/001c.30021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/04/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of forefoot related problems in athletes, there are few comprehensive summaries on examination and intervention strategies for those with forefoot related symptoms. While many factors may contribute to pathology and injury, the presence of abnormal foot alignment can negatively affect lower extremity biomechanics and be associated with injuries. Physical therapists may use the characteristics associated abnormal pronation or abnormal supination to describe the movement system disorder and serve as a guide for evaluating and managing athletes with forefoot pathologies. Athletes with an abnormal pronation movement system diagnosis typically demonstrate foot hypermobility, have decreased strength of the tibialis posterior muscle, and present with a medially rotated lower extremity position. Athletes with abnormal supination movement system diagnosis typically demonstrate foot hypomobility, decreased strength of the fibularis muscles, and a laterally rotated lower extremity position. Interventions of manual therapy, taping, strengthening exercises, and neuromuscular reeducation can be directed at the identified impairments and abnormal movements. The purpose of this clinical commentary is to integrate a movement system approach in pathoanatomical, evaluation, and intervention considerations for athletes with common forefoot pathologies, including stress fractures, metatarsalgia, neuroma, turf toe, and sesamoiditis. By applying a prioritized, objective problem list and movement system diagnosis, emphasis is shifted from a pathoanatomical diagnosis-based treatment plan to a more impairment and movement focused treatment. LEVEL OF EVIDENCE 5.
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5
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Wang JE, Bai RJ, Zhan HL, Li WT, Qian ZH, Wang NL, Yin Y. High-resolution 3T magnetic resonance imaging and histological analysis of capsuloligamentous complex of the first metatarsophalangeal joint. J Orthop Surg Res 2021; 16:638. [PMID: 34689814 PMCID: PMC8543817 DOI: 10.1186/s13018-021-02795-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are discrepancies in the understanding of the structure of the capsuloligamentous complex of the first metatarsophalangeal joint (MTPJ); this study aims to investigate the differences with previous anatomical reports of high-resolution 3T magnetic resonance imaging (MRI) and histological analysis in illustrating the structure of the capsuloligamentous complex of the first MTPJ. Methods Nine fresh frozen cadaveric feet specimens (from two women and three men; aged 32 to 58 years) were used in this study. All specimens underwent MR examination with T1-weighted imaging and T2-weighted spectral attenuated inversion recovery in three planes. Subsequently, all cadaveric feet specimens were sliced into 2-mm-thick sections. The MRI features of the capsuloligamentous complex of the first MTPJ were analyzed in these specimens. Hematoxylin–eosin and Masson’s trichrome staining methods were used to explore the histologic features of the capsuloligamentous complex of the first MTPJ. Results Different from most previous studies, our results showed that the plantar plate could be divided into four portions including the central portion of the plantar plate, the intersesamoid, the sesamoid phalangeal and the metatarsosesamoid ligaments. The normal central portion of the plantar plate could be clearly visualized in the sagittal and coronal plane MR images. The intersesamoid ligament is a continuation of the central portion of the plantar plate on the sagittal plane on the gross specimen, the MR imaging, and the histological examination. On the coronal plane of the gross specimen and MR imaging, the sesamoid phalangeal ligaments and the central portion of the plantar plate can be seen as separate ligaments, but they appeared interwoven with the same continuous collagenous fibers on the histological analysis. Conclusion High-resolution 3T MRI allows accurate demonstration of the different anatomical details of the capsuloligamentous complex of the first MTPJ from previous anatomical reports. The histological analysis provides further understanding of the structures of the capsuloligamentous complex of the first MTPJ from previous studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02795-7.
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Affiliation(s)
- Jin-E Wang
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China
| | - Rong-Jie Bai
- Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China. .,Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Hui-Li Zhan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Wen-Ting Li
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Nai-Li Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yuming Yin
- Direct Radiology, 3501 Ocean Drive, Corpus Christi, TX, 78411, USA
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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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7
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Kim HG, Choi HY, Park JS, Ryu KN, Park SY, Jin W. Clinical Features and Radiological Differential Diagnoses of Symptomatic Sesamoid Bones and Accessory Ossicles: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:82-98. [PMID: 36237464 PMCID: PMC9432401 DOI: 10.3348/jksr.2020.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022]
Abstract
종자골과 부골은 정상 해부학적 변이로 그 빈도와 형태는 다양하며 일반적으로 크기가 작고 둥근 모양으로 피질로 잘 둘러싸여 있고 뼈나 관절 주위에 인접하여 관찰되고 드물게 이분 혹은 다분 형태를 보일 수 있다. 대부분의 종자골과 부골은 무증상이며 판독 업무 중에 흔히 마주치게 된다. 하지만 때때로 종자골과 부골이 증상을 일으킬 수 있는데, 종자골과 부골 자체의 골절이나 탈구, 관절염, 골괴사, 감염 등의 질환이 이환되거나, 주변에 신경압박이나 건초염, 연부조직의 포착 등에 의하여 증상을 유발할 수 있다. 이 종설에서는 다양한 해부학적 위치에서 발생한 증상이 있는 종자골과 부골의 영상을 보고, 이들의 임상적 양상과 영상의학적 감별진단을 정리해보고자 한다.
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Affiliation(s)
- Hyun Gun Kim
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Young Choi
- Department of Radiology, DongSuWon General Hospital, Suwon, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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8
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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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Tafur M, Bencardino JT, Roberts CC, Appel M, Bell AM, Gyftopoulos S, Metter DF, Mintz DN, Morrison WB, Small KMS, Subhas N, Weissman BN, Yu JS, Kransdorf MJ. ACR Appropriateness Criteria® Chronic Foot Pain. J Am Coll Radiol 2020; 17:S391-S402. [PMID: 33153552 DOI: 10.1016/j.jacr.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | | | | | | | | | | | | | | | - Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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10
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Bilateral Sesamoiditis as First Manifestation of Gout. Case Rep Orthop 2020; 2020:8890549. [PMID: 32963862 PMCID: PMC7499288 DOI: 10.1155/2020/8890549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Sesamoiditis secondary to gout is an extremely rare condition with few case reports in the literature. It is an important differential diagnosis because the treatment depends on targeted therapy, unlike the main causes of sesamoiditis that often involves immobilization with special orthoses and prescription of anti-inflammatory drugs. We report here a case of a 38-year-old male, athlete, with bipartite medial sesamoid, who had insidious pain in the base of the left hallux. Laboratory tests showed no alterations, and imaging examinations demonstrated sesamoiditis with suspicion of stress fracture. The patient was initially prescribed an immobilization boot and analgesic and anti-inflammatory drugs, but he did not respond to the measures taken. After the onset of the same condition in the contralateral foot and getting the same imaging findings, we began an investigation of systemic disease, focusing on gout, because of a positive family history, which was confirmed by dual-energy computed tomography.
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11
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Hood CR, Riding PJ, Cook AC. Another Classification of First Metatarsophalangeal Joint Dislocation-Type 3: Review and Case Description of the Plantar Dislocation. J Foot Ankle Surg 2019; 58:534-539. [PMID: 30902493 DOI: 10.1053/j.jfas.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 02/03/2023]
Abstract
Plantar dislocation of the first metatarsophalangeal joint is a possible, albeit rare, injury to the foot. The mechanism has been attributed to a hyperflexion motion, with the hallux situated plantar to the first metatarsal head. In this article, we provide a case example of an open, plantar dislocation of the first metatarsophalangeal and perform a literature review of this rare injury. Based on x-ray analysis of the published cases, the sesamoids may or may not dislocate with the phalanx based off of the local capsuloligamentous anatomy. As a result, a modified Jahss classification (type 3A and type 3B) has been proposed to amend the existing system, adding plantar dislocations of the first metatarsophalangeal without (type 3A) and with (type 3B) sesamoid dislocation.
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Affiliation(s)
- Christopher R Hood
- Fellowship-Trained Foot and Ankle Surgeon, Premier Orthopaedics and Sports Medicine, Malvern, PA.
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12
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Ashimolowo T, Dunham G, Sharp JW, Porrino J. Turf Toe: An Update and Comprehensive Review. Radiol Clin North Am 2018; 56:847-858. [PMID: 30322486 DOI: 10.1016/j.rcl.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Turf toe is a spectrum of injury involving the first metatarsophalangeal joint originally described in football players on artificial surfaces. A detailed description of the complex anatomy and pathology involved in the turf toe injury is presented. We highlight potential pitfalls of image interpretation and emphasize what the referring physician needs to know.
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Affiliation(s)
- Tolu Ashimolowo
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-7117, USA
| | - Gregor Dunham
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-7117, USA
| | - Jake W Sharp
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-7117, USA
| | - Jack Porrino
- Radiology and Biomedical Imaging, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA.
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13
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De Maeseneer M, Moyson N, Lenchik L, Cattrysse E, Scafoglieri A, Roose R, Shahabpour M. MR imaging-anatomical correlation of the metatarsophalangeal joint of the hallux: Ligaments, tendons, and muscles. Eur J Radiol 2018; 106:14-19. [PMID: 30150036 DOI: 10.1016/j.ejrad.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To perform an MR imaging-anatomical correlation to elucidate the anatomy of muscles, tendons, and ligaments about the hallux as seen on MR imaging. MATERIALS AND METHODS Four fresh and 4 embalmed cadaver specimens were used for this study. The embalmed specimens and one fresh specimen were dissected by three investigators. The fresh specimens were preserved deep frozen. They were thawed and imaged with a 3 T MR system. Proton density weighted images were obtained. The specimens were refrozen and sectioned with a band saw into 3 mm thick slices. RESULTS Musculotendinous structures were equally well seen in the fresh and embalmed specimens. The capsular ligaments could best be studied in the fresh specimens. Proximal to the sesamoids the following muscle and tendon anatomy was delineated: the abductor hallucis tendon inserted on the medial sesamoid bone together with the medial belly of the flexor digitorum brevis; the adductor hallucis (transverse and oblique heads) inserted on the lateral sesamoid together with the lateral head of the flexor hallucis brevis. At the level of the sesamoid bones and distally, the ligaments making up the plantar plate were delineated, including the presesamoid band, the flexor hallucis longus pulley, the sesamometatarsal ligaments, the sesamophalangeal ligaments, and the capsular ligaments. CONCLUSION MRI allows for accurate assessment of the complex anatomy of the hallux. At the level proximal to the sesamoids the muscle and tendon insertions are well demonstrated. At the level of the sesamoids and distally, the ligaments making up 'the plantar plate' are well demonstrated.
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Affiliation(s)
| | - Nicolas Moyson
- Department of Experimental Anatomy, VUB, Brussels, Belgium
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Erik Cattrysse
- Department of Experimental Anatomy, VUB, Brussels, Belgium
| | | | - Ruben Roose
- Department of Radiology, UZ Brussel, Brussels, Belgium
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14
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Fiacco RC, Ream GM, Wilson C, Tubbs RS, Loukas M, Kozlowski PB, DiLandro AC, Jules KT, D'Antoni AV. Relationship Between the Intersesamoid Ligament and Sesamoid Bones in Cadaveric Feet with Hallux Valgus. Cureus 2017; 9:e1819. [PMID: 29312840 PMCID: PMC5752227 DOI: 10.7759/cureus.1819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is heterogeneity in the literature regarding the anatomy, exact location, and definition of the intersesamoid ligament (IL). Anatomic knowledge of the IL and its variations are important for surgeons who undertake corrective surgery for hallux abducto valgus (HAV). The IL was dissected in 16 feet from 32 formalin-fixed cadavers (12 females, four males; mean age at death, 76.6 years) to examine its morphology. The length, width, and thickness of its constituent bands were recorded with a digital caliper. Descriptive and correlational statistics were used to investigate the relationships between band size, age at death, and sex. A literature review was conducted to compare our data to those of previous studies. Results suggest that the size of the sesamoids may change as a result of HAV deforming forces, which may cause lengthening of the IL. The IL stabilizes the sesamoid apparatus of the first metatarsophalangeal joint (MPJ) and should be evaluated in HAV correction. Anatomic knowledge of the complex morphology and relations between the IL and sesamoids is critically important for surgeons correcting HAV deformities.
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Affiliation(s)
| | | | | | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | | | - Anthony C DiLandro
- Division of Pre Clinical Sciences, New York College of Podiatric Medicine
| | - Kevin T Jules
- Department of Surgery, New York College of Podiatric Medicine
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15
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Linklater JM, Hayter CL, Vu D. Imaging of Acute Capsuloligamentous Sports Injuries in the Ankle and Foot: Sports Imaging Series. Radiology 2017; 283:644-662. [DOI: 10.1148/radiol.2017152442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- James M. Linklater
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
| | - Catherine L. Hayter
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
| | - Dzung Vu
- From Castlereagh Imaging, 60 Pacific Hwy, St Leonards, Sydney, NSW, Australia 2065 (J.M.L., C.L.H.); and Department of Anatomy, School of Medical Science, University of Notre-Dame Australia, Sydney, Australia (D.V.)
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16
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Nouh MR, Abd El-Gawad EA, Abdulsalam SM. MRI utility in patients with non-traumatic metatarsalgia: A tertiary musculoskeletal center observational study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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17
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Abstract
Sports injuries of the midfoot and forefoot encompass a spectrum of osseous and soft tissue trauma. Magnetic resonance imaging serves as a primary or important supplementary diagnostic modality in evaluation of various injuries, most important of which include Lisfranc complex injury, stress fractures, and injury to the first metatarsophalangeal joint, aka "turf toe." Current technical advances in magnetic resonance and improved knowledge of regional anatomy enable thorough evaluation of the complex anatomic structures of the foot and facilitate accurate diagnosis in the setting of trauma.
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Affiliation(s)
- Tetyana Gorbachova
- From the Department of Radiology, Einstein Medical Center, Philadelphia, PA
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18
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Abstract
Sports injuries of the foot can occur as sequelae of acute trauma or chronic overuse. Besides clinical examination, imaging plays a major role in the detection of structural abnormalities and the differential diagnostics. This article reviews the most important sports-related soft tissue and bone pathologies of the forefoot and midfoot together with their typical findings on radiography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).
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Favinger JL, Porrino JA, Richardson ML, Mulcahy H, Chew FS, Brage ME. Epidemiology and imaging appearance of the normal Bi-/multipartite hallux sesamoid bone. Foot Ankle Int 2015; 36:197-202. [PMID: 25237171 DOI: 10.1177/1071100714552484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Turf toe is a hyperextension injury of the hallux metatarsophalangeal joint that can be difficult to diagnose on physical examination and imaging. Diastasis of the bi- or multipartite sesamoid of the hallux has been implicated as 1 potential radiographic finding of turf toe injury, and when present may require operative management. However, the normal interval for the bi-/multipartite sesamoid has not yet been established. METHODS A total of 671 foot radiograph series were reviewed in effort to quantify the dominant interval of the bi-/multipartite sesamoid bone with respect to potential influencing factors including right versus left foot, medial and/or lateral sesamoid involvement, patient age and gender, and weight versus non-weight-bearing radiograph technique. RESULTS The prevalence of a bi-/multipartite hallux sesamoid was 14.3% in our population. The dominant sesamoid interval ranged from 0-2 mm, with an average of 0.79 mm. CONCLUSION We conclude that sesamoid diastasis should be considered, in the appropriate clinical setting, when the sesamoid interval is greater than 2 mm on a routine AP radiograph of the foot. LEVEL OF EVIDENCE Level III, comparative study.
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20
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First metatarsophalangeal joint- MRI findings in asymptomatic volunteers. Eur Radiol 2014; 25:970-9. [PMID: 25413967 DOI: 10.1007/s00330-014-3489-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/20/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the spectrum and frequency of MR findings of the first metatarsophalangeal joint (MTPJ) in asymptomatic volunteers. METHODS MR imaging of 30 asymptomatic forefeet was performed with a dedicated extremity 1.5-Tesla system. Participants were between 20 and 49 years of age (mean ± SD: 35.5 ± 8.4 years). Two radiologists assessed cartilage, bone, capsuloligamentous structures, and tendons of first MTPJs on MR images. RESULTS Cartilage defects were observed in 27 % (n = 8) of first MTPJs, most frequently located at the base of the proximal phalanx (23 %, n = 7), whereas cartilage defects of the metatarsal head (13 %, n = 4) and the metatarsosesamoid compartment were rare (0 %-3 %, n = 0-1). Bone marrow oedema-like signal changes were present in 37 % (n = 11) and subchondral cysts in 20 % (n = 6) of first MTPJs. Hyperintense areas on intermediate-weighted sequences (range: 30-43 %, n = 9-13) and on fluid-sensitive sequences with fat suppression (range: 33-60 %, n = 10-18) within the medial and lateral collateral ligament complex were common. Plantar recesses (77 %, n = 23) and distal dorsal recesses (87 %, n = 26) were frequently observed. CONCLUSIONS Cartilage defects, bone marrow oedema-like signal changes, subchondral cysts, plantar recesses, and distal dorsal recesses were common findings on MRI of first MTPJs in asymptomatic volunteers. The collateral ligaments were often heterogeneous in structure and showed increased signal intensity. KEY POINTS • Cartilage defects of asymptomatic first metatarsophalangeal joints were common on MRI. • The collateral ligaments were often heterogeneous in structure and showed increased signal intensity. • Areas of increased signal intensity within the flexor and extensor tendons were rare. • These observations need to be considered in MR examinations of symptomatic cases.
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21
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Sims AL, Kurup HV. Painful sesamoid of the great toe. World J Orthop 2014; 5:146-150. [PMID: 24829877 PMCID: PMC4017307 DOI: 10.5312/wjo.v5.i2.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/01/2014] [Accepted: 01/16/2014] [Indexed: 02/06/2023] Open
Abstract
The painful sesamoid can be a chronic and disabling problem and isolating the cause can be far from straightforward. There are a number of forefoot pathologies that can present similarly to sesmoid pathologies and likewise identifying the particular cause of sesamoid pain can be challenging. Modern imaging techniques can be helpful. This article reviews the anatomy, development and morphological variability present in the sesamoids of the great toe. We review evidence on approach to history, diagnosis and investigation of sesamoid pain. Differential diagnoses and management strategies, including conservative and operative are outlined. Our recommendations are that early consideration of magnetic resonance imaging and discussion with a specialist musculoskeletal radiologist may help to identify a cause of pain accurately and quickly. Conservative measures should be first line in most cases. Where fracture and avascular necrosis can be ruled out, injection under fluoroscopic guidance may help to avoid operative intervention.
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22
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Chen TW, Lin CW, Lee CL, Chen CH, Chen YJ, Lin TY, Huang MH. The efficacy of shock wave therapy in patients with knee osteoarthritis and popliteal cyamella. Kaohsiung J Med Sci 2014; 30:362-70. [PMID: 24924842 DOI: 10.1016/j.kjms.2014.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022] Open
Abstract
This randomized, controlled study was performed to compare the effects of extracorporeal shockwave therapy (ESWT) and ultrasound on the rehabilitation of knee osteoarthritis with popliteal cyamella. One hundred and twenty patients with bilateral moderate knee osteoarthritis (Altman III) and popliteal cyamella were selected and randomly assigned to four groups (GI-GIV). Patients in Groups I-III received isokinetic muscular strengthening exercises three times weekly for 8 weeks. Group II received pulse ultrasound treatment for popliteal cyamella three times weekly for 8 weeks, Group III received weekly shock wave therapy for popliteal cyamella for the first 6 weeks, and Group IV acted as controls. The therapeutic effects were evaluated by changes in the arthritic knees range of motion (ROM), visual analogue scale, Lequesne's index, and muscle peak torques after treatment and at follow-up 6 months later. Each treated group exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-ups. However, only patients in Groups II and III showed significant improvements in ROM after treatment, and only participants in Group III showed immediate improvement in ROM after each treatment. Patients in Group III also showed the greatest increase in muscular strength and the greatest decrease in disability after treatment and at the follow-ups. ESWT is better than pulse ultrasound in rehabilitation of patients with knee osteoarthritis and popliteal cyamella results in more functional improvements.
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Affiliation(s)
- Tien-Wen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Wei Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Ling Lee
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Jen Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tz-Yan Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mao-Hsiung Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Neuroscience, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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23
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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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24
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Abstract
The first metatarsal articulation bears one third of the weight of the forefoot. The hallucal sesamoids are embedded in the flexor hallucis brevis and connected by the intersesamoid ligament and plantar plate. The sesamoid apparatus acts as a pulley to help pull the big toe down against the ground during walking. Repetitive pressure, force, or tension can cause sesamoiditis. If the impact is great enough, the bones can break. Here we present a woman with big toe pain during walking. Our case highlights the role of 99mTc-MDP bone scan in reaching the diagnosis of hallucal sesamoiditis.
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25
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Arbab D, Wingenfeld C, Rath B, Lüring C, Quack V, Tingart M. [Osteochondrosis of the pediatric foot]. DER ORTHOPADE 2012; 42:20-9. [PMID: 23254328 DOI: 10.1007/s00132-012-1988-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Osteochondrosis is a heterogeneous group of self-limiting conditions characterized by disturbance of enchondral ossification caused by a lack of circulation. Foot pain is a relatively common problem in children and adolescents and may be due to osteochondrosis. Osteochondrosis of the growing foot shows painful radiological alterations including increased density, fragmentation and irregularity of the epiphyses, physes and apophyses. Lacking etiologic and pathophysiologic information, ostoechondroses have been documented in almost every bone of the foot and therefore should be considered in the differential diagnosis when evaluating pediatric foot pain. The most common localizations of osteochondroses of the growing foot include the navicular as Kohler's syndrome, the metatarsal as Freiberg's infraction and calcaneal apophysitis as Sever's disease. Prognosis and final outcome vary considerably between the different localizations. Physicians should therefore be informed about the etiology, clinical presentation and treatment options for osteochondroses of the growing foot.
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Affiliation(s)
- D Arbab
- Klinik für Orthopädie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Sharma P, Singh H, Agarwal KK, Sudhir KS, Khangembam BC, Bal C, Malhotra A, Kumar R. Utility of (99m)Tc-MDP SPECT-CT for the diagnosis of sesamoiditis as cause of metatarsalgia. Indian J Nucl Med 2012; 27:45-7. [PMID: 23599600 PMCID: PMC3628263 DOI: 10.4103/0972-3919.108865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Metatarsalgia is a general term for pain in the area of the metatarsophalangeal joints. Sesamoiditis is an uncommon cause of metatarsalgia. It is pain at the sesamoid bones beneath the head of the first metatarsal with inflammation or fracture. The diagnosis is usually clinical, with localized tenderness on palpation. Diagnosing the cause of metatarsalgia in patients without this classical sign is difficult. We present here such a case of a 37-year-old lady in whom sesamoiditis was diagnosed with technetium-99m (99mTc)-methylene diphosphonate (MDP) single photon emission tomography-computed tomography (SPECT-CT).
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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28
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Boike A, Schnirring-Judge M, McMillin S. Sesamoid disorders of the first metatarsophalangeal joint. Clin Podiatr Med Surg 2011; 28:269-85, vii. [PMID: 21669339 DOI: 10.1016/j.cpm.2011.03.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The sesamoid complex is located centrally and plantar to the first metatarsal head, where they are imbedded within the plantar plate, which transmits 50% of body weight and more than 300% during push-off, is susceptible to numerous pathologies. These pathologies include sesamoiditis, stress fracture, avascular necrosis, osteochondral fractures, and chondromalacia, and are secondary to these large weight-bearing loads. This article discusses sesamoid conditions and their relationship with hallux limitus, and reviews the conditions that predispose the first metatarsophalangeal joint to osteoarthritic changes.
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Affiliation(s)
- Allan Boike
- Foot and Ankle Center, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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29
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Benthien JP, Brunner A. A symptomatic sesamoid bone in the popliteus muscle (cyamella). Musculoskelet Surg 2010; 94:141-144. [PMID: 21104175 DOI: 10.1007/s12306-010-0083-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 10/19/2010] [Indexed: 05/30/2023]
Abstract
Sesamoid bones of the popliteus muscle, also called cyamellae, are common in primates but rare in humans. They reside as accessory bones in the tendon itself or in the intersection between tendon and bone. They should be clearly distinguished from osteochondral flakes, periosseuos calcifications, osteophytes and the fabella, a common sesamoid bone of the knee. In this case, we report a 25-year-old male with posterior lateral knee pain related to the popliteus tendon where a corresponding cyamella could be demonstrated on X-rays and MRI scans. The clinical findings may be related to the cyamella. Diagnosis and treatment of this rare pathology are discussed.
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