Adolescent hallux valgus deformity with bilateral absence of the hallucal sesamoids: a case report

Congenital Absence of Tibial Sesamoids, With Alternate Insertions of the Flexor Hallucis Brevis Tendon

There have been a dozen case reports of congenital absence of pedal sesamoid absence. We present the first documented case of congenital bilateral absence of tibial sesamoids with use of magnetic resonance imaging to identify a naturally occurring compensatory aberration of the flexor hallucis brevis. The right foot had bifurcation of the flexor hallucis brevis with one slip blending into the abductor hallucis tendon and capsule and the other slip traversing laterally and attaching to lateral flexor hallucis brevis tendon and fibular sesamoid. On the left foot, the entire flexor hallucis brevis traversed laterally and attached onto the fibular sesamoid and lateral flexor hallucis brevis. The present findings of this patient's anatomical variation could help provide valuable information to prevent known deformities that are the sequalae of a tibial sesamoidectomy.

Imaging Findings of Bilateral Medial Hallucal Sesamoid Insufficiency in a Marathon Runner

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.

Congenital missing tibial sesamoid in a marathon runner: a case report

The absence of the hallucal tibial sesamoid is seldom seen in the clinical setting. We present a case of a symptomatic missing tibial sesamoid in a female marathon runner.

Fact or fiction? Iatrogenic hallux abducto valgus secondary to tibial sesamoidectomy

First ray function and hallux misalignment after isolated tibial sesamoidectomy have been topics of debate. Although sesamoidectomy has been proved to be effective in the relief of sesamoid pain, many foot and ankle surgeons remain hesitant to perform the procedure fearing a possible joint perturbation. To our knowledge, the present study is the first to evaluate both laboratory and clinical evidence of the association between isolated tibial sesamoidectomy and hallux abducto valgus deformity. The bench study consisted of 10 cadaveric limbs that were dissected and prepared for testing. Controlled valgus loads were applied before and after tibial sesamoidectomy. No significant difference was found in the joint position after sesamoidectomy in both the rectus (p = .36) and the dorsiflexed (p = .062) positions. The clinical evaluation consisted of a retrospective cohort of 5 females; all of whom underwent isolated tibial sesamoidectomy. The pre- and postoperative radiographs and self-reported pain scores (visual analog scale) were compared. None of the patients developed a postoperative hallux abducto valgus deformity. Neither the hallux abductus angle (p = .180) nor the intermetatarsal angle 1-2 (p = .180) changed significantly in the postoperative setting. The visual analog scale pain scores changed from a mean of 6.8 to 1, a significant difference (p = .042). Based on our observations and clinical experience, we believe that isolated tibial sesamoidectomy does not have a significant effect on the position of the first metatarsophalangeal joint when meticulous surgical technique is used to excise the sesamoid. Isolated tibial sesamoidectomy can provide substantial pain relief and appears to be a safe treatment for a variety of conditions affecting the tibial sesamoid.

Hallux valgus deformity associated with bilateral absence of the tibial and fibular hallucal sesamoids

The absence of both tibial and fibular hallucal sesamoids is an extremely rare condition. It can present as hallux valgus, hallux varus, or metatarsalgia. It can result from primary mesenchymal differentiation failure or an ossification problem. Preoperative magnetic resonance imaging can help to differentiate the problem and assist preoperative planning in the case of surgical correction of the associated hallux valgus deformity.