Hallucal Sesamoids Research Articles

Hallucal sesamoid injury

The hallucal sesamoid complex is a unique anatomical structure, which can be responsible for significant athletic disability. The medial sesamoid is typically injured due to its position and size. Conditions presented in this paper include sesamoiditis, stress fracture, acute trauma, and nonunion. Surgical techniques applicable to medial sesamoid pathology are evolving, and those discussed include sesamoid excision, bone grafting for nonunions, and sesamoid complex reconstruction with partial sesamoidectomy for trauma.

Gout: Rare Cause of Hallucal Sesamoid Pain: A Case Report

Tophaceous gout is commonly encountered and is amenable to effective medical management. A rare case of tophaceous gout in a tripartite medial sesamoid bone of the great toe is presented. Clinical presentation, differential diagnosis, and treatment of hallucal sesamoid pain are discussed.

Bone scintigraphy in the assessment of the hallucal sesamoids.

Bone scintigraphy is frequently used to evaluate suspected hallucal sesamoid pathology. Increased scintigraphic activity of the hallucal sesamoid is assumed to corroborate clinical suspicion of pathology, but the incidence of such increased uptake has not been studied in an asymptomatic population. Using a 0 to 2 bone scintigraphic rating system, 25 of 86 (29%) asymptomatic infantry recruits and 7 of 27 (26%) asymptomatic sedentary adults were found to have grade 1 or grade 2 activity. When using scintigraphy to evaluate hallucal sesamoid pathology, caution should be used in interpreting the meaning of increased scintigraphic activity.

Clinical sign consistent with the hallucal interphalangeal sesamoid

Clinical sign consistent with the hallucal interphalangeal sesamoid

The blood supply to the great toe sesamoids.

The purpose of this study was to define the intraosseous and extraosseous blood supply of the hallucal sesamoids by studying a total of 10 fresh-frozen, below-knee specimens with no evidence of vascular disease. Most specimens were injected with high grade India ink, cleared using a standard Spalteholz technique, and processed to delineate the extraosseous and intraosseous blood supply to include soft tissue dissection and coronal sectioning. Two additional specimens were injected with blue Mercox acrylic solution to further define the extraosseous vasculature. The major extraosseous blood supply to the sesamoids is via the posterior tibial artery. This vessel then branches into the medial plantar artery which further divides upon entering the medial and lateral sesamoids in their proximal poles. Vessels in the peripheral soft tissues, although abundant, do not seem to penetrate the cortex of the sesamoids. The intraosseous blood supply to the sesamoids seems to be threefold. Mainly, sesamoid arteries enter the lateral and medial sesamoids from the proximal aspect via a single vessel. This proximal vessel proceeds distally with a network of branching. Plantar, nonarticular vessels enter the sesamoids, constituting a second source of vascularity. Finally, small vessels also enter the sesamoids through medial and lateral capsular attachments. Based on this study, a possible explanation for avascular necrosis and nonunion of sesamoids is proposed, and an optimal surgical approach is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Sesamoid Disorders and Treatment An Update

The anatomy, function, and disorders of the hallucal sesamoids show that the diagnosis and current concept of management are based on the individual patient's problems. The treatment should always be initiated in a conservative fashion, generally using a molded insole with an appropriate excavation to shift weight from a painful sesamoid. The advantages and disadvantages of sesamoidectomy are influenced by surgical technique. Care in handling the medial and lateral hallucal nerves is essential. Removal of both the medial and lateral sesamoids invariably leads to an intractable clawtoe deformity and is absolutely contraindicated.

First metatarsophalangeal joint arthrodesis. Treatment for sesamoid fractures

Fractures of both hallucal sesamoids are not commonly reported in the literature. The authors address various surgical procedure choices and present a case history. In their case, conservative treatment failed; therefore, surgical intervention was elected, and fusion of the first metatarsophalangeal joint was performed.

Subchondral bone cysts of the phalanges

Subchondral phalangeal bone cysts frequently are encountered when reviewing foot x-rays. Radiologically, these lesions appear as a focus of subchondral radiolucency surrounded by a rim of sclerotic bone. Radiologic and histologic examinations demonstrate that these lesions are identical to the subchondral bone cysts associated with osteoarthritis of the hip and the more recently described cysts of the hallucal sesamoids and the head of the first metatarsal.