Medial Sesamoid Research Articles

Medial Sesamoid Nonunion Combined with Hallux Valgus in Athletes: A Report of Two Cases

Medial Sesamoid Nonunion Combined with Hallux Valgus in Athletes: A Report of Two Cases

Callus Formation of the Tibial Hallux Sesamoid Mimicking a Bone Tumor

Sesamoid tumors of the hallux are rare, and their incidence and differential diagnosis have not been well described. We present a case with a bizarre callus formation of the medial sesamoid of the hallux that mimicked a bone tumor. After excision of the mass and related sesamoid, the patient remained asymptomatic during 3 years of follow-up.

RADIOLOGIC ANATOMY OF THE NORMAL APPENDICULAR SKELETON OF THE LION (PANTHERA LEO). PART 2: PELVIC LIMB

Pelvic limb specimens from 14 euthanized free-ranging lions (Panthera leo), ranging in age from 16 to 170 mo, underwent radiographic evaluation in the manner described for thoracic limbs in part I of this study. On the basis of these specimens, the femur of the lion is similar to that of domestic cats, but the cranial and caudal middiaphyseal cortices are markedly thickened. The patella has a long narrow apex and flat broad base. There is a prominent lateral Os sesamoideum m. gastrocnemii. A small medial sesamoid is occasionally present, and meniscal ossicles are usually present. The head and distal extremity of the fibula are very prominent. The tarsal joint is similar to that of domestic cats. Metatarsals II-V are up to 25 mm longer than the corresponding metacarpals. All physes close by 54 mo of age.

Sesamoids of the foot

Summary Sesamoids are inter-tendinous bones and the constant ones are the medial and lateral sesamoids of the first metatarsophalangeal joint. Accessory sesamoids occur elsewhere and are rare. Sesamoiditis, infection, fracture and bipartite sesamoid are the common associated conditions. Treatment should be conservative in the first instance. Sesamoidectomy may be necessary but removal of both big toe sesamoids in contra-indicated.

Bilateral osteochondritis of the medial hallucial sesamoids in a 12-year-old

We report an unusual case of bilateral osteochondritis of the tibial (medial) hallucial sesamoids in a 12-year-old rugby player. He was referred with an 18 month history of disabling bilateral plantar first metatarsophalangeal joint pain that did not respond to conservative treatment. The diagnosis of sesamoid osteochondritis is usually delayed because radiological changes do not occur for up to twelve months following the onset of symptoms. Diagnostic radiological changes are best seen on axial sesamoid plain radiographs and computerized tomograms. It is difficult to differentiate between sesamoiditis and true or stress fractures of the sesamoid. The initial treatment of clinical sesamoiditis is conservative. In this case bilateral medial hallucial sesamoidectomy provided complete and sustained relief of symptoms. At 6 month follow up the boy remains symptom free and has returned to normal sporting activity.

Ex vivo investigation of the use of hydrothermal energy to induce chondrocyte necrosis in articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of horses

To evaluate the use of hydrothermal ablation of articular cartilage for arthrodesis in horses through investigation of the effects of joint lavage with physiologic saline (0.9% NaCI) solution (80 degrees C) for various treatment times on chondrocyte viability in the articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of cadaveric horse limbs. Sample Population-7 pairs of metacarpophalangeal and 8 pairs of metatarsophalangeal joints from 8 Thoroughbreds. The horses were euthanatized for reasons unrelated to musculoskeletal disease. On a random basis, 1 joint of each pair underwent intra-articular lavage for 5, 10, or 15 minutes with heated saline solution (80 degrees C); the other joint underwent sham treatment of similar duration with saline solution at 22 degrees C (control). Cartilage samples from the distal articular surface of metacarpus III (or metatarsus III), the proximal surface of the proximal phalanx, and the lateral and medial proximal sesamoid bones were assessed for chondrocyte viability via confocal microscopy and viability staining following enzymatic digestion. Compared with the control joints, findings of both viability assays indicated that the percentage of sites containing viable chondrocytes in heat-treated joints was decreased. Treatment hazard ratios of 0.048 (confocal microscopy) and 0.2 (digestion assay) were estimated. Histologically, periarticular soft tissues had minimal detrimental effects after heat treatment. Ex vivo intra-articular lavage with saline solution at 80 degrees C resulted in the death of almost all articular chondrocytes in the joint. This technique may be a satisfactory method for extensive cartilage ablation when performing arthrodesis by minimally invasive techniques.

The sesamoid index in psoriatic arthropathy

The sesamoid index was originally described as an aid to the diagnosis of acromegaly. We performed this study to assess the value of the thumb sesamoid index in the diagnosis of psoriatic arthropathy. Retrospective measurement of the sesamoid index (length x width of the medial thumb sesamoid), along with the age and sex were recorded for patients as described below. Patients with psoriasis were subdivided into those with or without radiographic evidence of hand arthropathy. Fifty-nine consecutive patients attending rheumatology clinics with arthralgia and psoriasis were studied. Comparison groups with radiographic evidence of rheumatoid arthritis (52 patients), osteoarthritis (44) or normal hands (55) were also recorded. Twenty-one of 59 patients with psoriasis and arthropathy had a sesamoid index>40, compared with two of 52 with rheumatoid arthritis, none of 44 with osteoarthritis and none of 55 normals. Psoriatic arthropathy is a recognised cause of bone enlargement, usually in the phalanges due to periostitis and proliferative enthesopathy. We have confirmed that psoriatic hand arthropathy can cause significant enlargement of the thumb sesamoids, a feature which is easily quantified and may assist diagnosis.

A radiographic evaluation of the scarf osteotomy for the correction of hallux valgus

A prospective radiographic study was performed on 13 patients (22 ft) undergoing SCARF osteotomy with an average age of 52 years (range, 25–78). Standardised weight bearing anterior-posterior radiographs were taken preoperatively and at 6 months post-operatively. These were compared to determine changes in the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA) and joint congruency angle (JCA). Correction of sesamoid position and metatarsal length changes were also assessed. The results showed a median reduction of IMA of 6°, HVA of 16°, DMAA of 6° and an improvement in JCA of 11°. Improvement of medial sesamoid displacement beneath the first metatarsal head was seen post-operatively. Metatarsal length was assessed by comparing the ratio of the length of the first to second metatarsal pre and post-operatively. No shortening was found. There was no incidence of avascular necrosis or delayed union. This study indicates that the SCARF osteotomy produces effective radiological correction of hallux valgus. It corrects sesamoid displacement and avoids shortening of the first metatarsal.

Stress fractures of the medial great toe sesamoids in athletes.

The purpose of this study was to determine whether specific symptoms and findings are present in patients with symptomatic stress fractures of the sesamoids of the great toe and, if so, whether partial sesamoidectomy is sufficient for successful treatment. Five consecutive athletes (five females; mean age 16.8 years [range, 13 to 22 years]) with six feet that were treated for symptomatic stress fractures of the sesamoids of the great toe were included in this study. Four athletes (five feet) performed rhythmic sports gymnastics; the fifth athlete was a long jumper. Some swelling to the forefoot and activity-related pain that increased in forced dorsiflexion, but disappeared at rest was found in all patients. While plain X-rays evidenced fragmentation of the medial sesamoid, MRI (n=2) and frontal plane CT scan (n=3) did not always confirm the diagnosis, but bone scan (n=3) and axial as well as sagittal CT scan were useful to detect the pathology. After failure of conservative treatment measures, surgical excision of the proximal fragment was successful in all patients, and there were no complications. All patients were pain free and regained full sports activity within six months (range, 2.5 to six months). At final follow-up which averaged 50.6 months (range, 20 to 110 months), the overall clinical results were graded as good/excellent in all patients, and there was only one patient with of restriction sports activities. The obtained AOFAS-Hallux-Score was 95.3 (75 to 100) points. Apparently, stress fractures occur more often at the medial sesamoid, and females are mainly involved. When a stress fracture is suspected, bone scan and CT scan are suggested as more reliable in confirming the diagnosis than other imaging methods. When conservative treatment has failed, surgical excision of the proximal fragment is recommended.

Percutaneous screw fixation for fractures of the sesamoid bones of the hallux.

Over a period of one year we treated nine fractures ofhe sesamoid bones of the hallux, five of which were in the medial sesamoid. All patients had symptoms on exercise, but only one had a recent history of injury. The mean age of the patients was 27 years (17 to 45) and there were six men. The mean duration of symptoms was nine months (1.5 to 48). The diagnosis was based on clinical and radiological investigations. We describe a new surgical technique for percutaneous screw fixation for these fractures using a Barouk screw. All the patients were assessed before and after surgery using the American Orthopaedic Foot and Ankle Society Hallux Score (AOFAS). There was a statistically significant improvement in the mean score from 46.9 to 80.7 (p = 0.0003) after fixation of the fracture with a rapid resolution of symptoms. All patients returned to their previous level of activity by three months. We believe that this relatively simple technique is an excellent method of treatment in appropriately selected patients.

Percutaneous screw fixation for fractures of the sesamoid bones of the hallux

Over a period of one year we treated nine fractures of the sesamoid bones of the hallux, five of which were in the medial sesamoid. All patients had symptoms on exercise, but only one had a recent history of injury. The mean age of the patients was 27 years (17 to 45) and there were six men. The mean duration of symptoms was nine months (1.5 to 48). The diagnosis was based on clinical and radiological investigations. We describe a new surgical technique for percutaneous screw fixation for these fractures using a Barouk screw. All the patients were assessed before and after surgery using the American Orthopaedic Foot and Ankle Society Hallux Score (AOFAS). There was a statistically significant improvement in the mean score from 46.9 to 80.7 (p = 0.0003) after fixation of the fracture with a rapid resolution of symptoms. All patients returned to their previous level of activity by three months. We believe that this relatively simple technique is an excellent method of treatment in appropriately selected patients.

Characterization of Hoxa-10/Hoxa-11 Transheterozygotes Reveals Functional Redundancy and Regulatory Interactions

Hox genes show related sequences and overlapping expression domains that often reflect functional redundancy as well as a common evolutionary origin. To accurately define their functions, it has become necessary to compare phenotypes of mice with single and multiple Hox gene mutations. Here, we focus on two Abd-B-type genes, Hoxa-10 and Hoxa-11, which are coexpressed in developing vertebrae, limbs, and reproductive tracts. To assess possible functional redundancy between these two genes, Hoxa-10/Hoxa-11 transheterozygotes were produced by genetic intercrosses and analyzed. This compound mutation resulted in synergistic defects in transheterozygous limbs and reproductive tracts, but not in vertebrae. In the forelimb, distal radial/ulnar thickening and pisiform/triangular carpal fusion were observed in 35 and 21% of transheterozygotes, respectively, but were effectively absent in Hoxa-10 and Hoxa-11 +/− forelimbs. In the hindlimb, distal tibial/fibular thickening and loss of tibial/fibular fusion were observed in >80% of transheterozygotes but in no Hoxa-10 or Hoxa-11 +/− hindlimbs, and all transheterozygotes displayed reduced medial patellar sesamoids, compared to modest incidences in Hoxa-10 and Hoxa-11 +/− mutants. Furthermore, while the reproductive tracts of Hoxa-10 and Hoxa-11 single heterozygous mutants of both sexes were primarily unaffected, male transheterozygotes displayed cryptorchidism and abnormal tortuosity of the ductus deferens, and female transheterozygotes exhibited abnormal uterotubal junctions and narrowing of the uterus. In addition we observed that the targeted mutations of Hoxa-10 and Hoxa-11 each affected the expression of the other gene in the developing prevertebra and reproductive tracts. These results provide a measure of the functional redundancy of Hoxa-10 and Hoxa-11 and a deeper understanding of the phenotypes resulting in the single mutants and help elucidate the regulatory interactions between these two genes.

Use of electrocautery probes in arthroscopic removal of apical sesamoid fracture fragments in 18 Standardbred horses.

To develop a technique for arthroscopic excision of apical sesamoid fracture fragments using electrocautery probes. A total of 18 Standardbred horses. Arthroscopic removal of apical sesamoid fracture fragments using both hook and loop electrocautery probes was performed on 18 Standardbred horses. The fracture fragments were approached using either an ipsilateral (3) or contralateral (15) arthroscopic triangulation technique. Distension of the metacarpo- (metatarso)-phalangeal joints was achieved using a 1.5% glycine solution. Under arthroscopic guidance, both the suspensory and intersesamoidean ligament attachments to the abaxial and the axial margins of the apical fragment were transected using a hook electrocautery probe. Subsequently, the palmar (plantar) soft tissue attachments to the apical fragment were transected with a loop electrocautery probe. Once freed of soft tissue attachments, the apical fragment was removed with Ferris-Smith intervertebral disc rongeur. The arthroscopic portals were closed in a routine manner. Horse ages ranged from 2 to 8 years (median, 2.5 years). Eighteen apical sesamoid fracture fragments were removed from the left (8) and right (8) hind limbs and the left (1) and right (1) forelimbs. Apical fragments occured in 15 lateral and 3 medial proximal sesamoid bones. No major complications occurred during or after surgery. The electrocautery probes permitted an easy and precise dissection of all soft tissue attachments to the apical sesamoid fracture fragments in all horses. Follow-up time was 7 to 44 months (median, 26 months); 10 of 14 horses returned to racing. Seven of nine horses that raced before surgery raced again and three of five that had not raced before surgery, raced afterwards. Arthroscopic excision of apical sesamoid fracture fragments can be accomplished arthroscopically using electrocautery probes. Arthroscopic electrosurgery is an efficient and safe alternative for intra-articular dissection in horses.

Insertion of the abductor hallucis muscle in feet with and without hallux valgus.

Textbooks of human anatomy present different opinions on the insertion of the abductor hallucis muscle which is concerned in etiology as well as in therapy of hallux valgus. In plastic and reconstructive surgery the muscle is taken as a graft for flap-surgery. In this study 109 feet (58 right, 51 left) were examined, 18 of these with clinical hallux valgus. The tendon of the muscle may attach to the tendon of the medial head of the short flexor hallucis muscle where a subtendineous bursa can be found. At the head of the first metatarsal bone the joint capsule is reinforced by fibres arising from the medial sesamoid bone which may be called "medial sesamoidal ligament." The tendon passes the first metatarsophalangeal joint plantarily to its transverse axis. Three types of insertion could be distinguished: type A, insertion at the proximal phalanx (N = 42); type B, insertion at the medial sesamoid ligament and at the medial sesamoid bone (N = 65); type C, insertion at the medial sesamoid bone (N = 2). In all types superficial fibres of the tendon extended to the medial and plantar sides of the base of the proximal phalanx, running in a plantar to dorsal direction. Statistical analysis exposed neither significant differences between both sides nor significant difference between normal feet and feet with hallux valgus. Therefore, a specific pattern of insertion of the abductor hallucis muscle in hallux valgus cannot be stated.

母し種子骨骨壊死，外けい骨骨壊死の２症例

Supranumerary bones and sesamoid bones can be found in the feet. We present two cases of the bone necroses of the supranumerary bone and sesamoid bone.Case 1 was a 56 years old female. She suffered pain under the first metatarsal head of the right great toe two months before her initial appearance. The initial examination found a localized tenderness over the medial sesamoid, and roentgenographic examination slowed irregularity and fragmentation of the medial sesamoid. Removal of the sesamoid bone was performed and necrosis of the bone was diagnosed by the pathological finding.Case 2 was a 49 years old male. He suffered from pain in his right foot 10 years ago. Though an arch support had been used for the treatment, however the pain became more severe 2 years back. Initial examination slowed a localized swelling over the right accessory navicular. Roentgenographic examination revealed irregularity and fragmentation of the accessory navicular. Removal of the accessory navicular was performed and bone necrosis was diagnosed by the pathological finding.

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.

Biomechanical Topography of Human Articular Cartilage in the First Metatarsophalangeal Joint

The objective of this study was to provide a map of cartilage biomechanical properties, thickness, and histomorphometric characteristics in the human, cadaveric first metatarsophangeal joint, to determine if normal articular cartilage was predisposed topographically to biomechanical mismatches in articulating surfaces. Cartilage intrinsic material properties and thickness were obtained from seven pairs of human, freshly frozen, cadaveric, metatarsophalangeal joints using an automated creep indentation apparatus under conditions of biphasic creep. Eight sites were tested: four on the metatarsal head, two on the proximal phalanx base, and one on each sesamoid bone to obtain the aggregate modulus, Poisson's ratio, permeability, shear modulus, and thickness. Cartilage in the lateral phalanx site of the left metatarsal head had the largest aggregate modulus (1.34 MPa), whereas the softest tissue was found in the right medial sesamoid (0.63 MPa). The medial phalanx region of the right joint was the most permeable (4.56 x 10(-15) meter4/Newton-second), whereas the medial sesamoid articulation of the metatarsal head of the left joint was the least permeable (1.26 x 10(-15) meter4/Newton-second). Material properties and thickness are indicative of the tissue's functional environment. The lack of mismatches in cartilage biomechanical properties of the articulating surfaces found in this study may be supportive of clinical observations that early degenerative changes, in the absence of traumatic events, do not occur at the selected test sites in the human first metatarsophalangeal joint.

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.

New radiologic diagnostic test for transverse platypodia

Radiologie examination of feet in axial plane was performed in 94 conscripts (188 feet) and 75 ambulant patients (115 feet). The main mechanism of transverse platypodia development was retraced in the sria roentgenograms of I metatarsosesamoid joint. Depending on the change of medial sesamoid articular surface position relative to the supportive plane 4 stages of transverse platypodia development were determined. The test for estimation of the value of I metatarsal osseous rotation based on the position of the articular surface of its head to the supportive plane was suggested.

The effect of hallux sesamoid excision on the flexor hallucis longus moment arm.

Surgical treatments for chronic, painful hallux sesamoid disorders typically involve partial or complete resection of 1 or both sesamoids. Although these approaches generally result in satisfactory symptom relief, their effect on biomechanical function of the major hallux flexors is not completely understood. The effects of selective sesamoid resections on the effective tendon moment arm of the flexor hallucis longus tendon were evaluated. Twelve fresh frozen cadaver first rays were each mounted in a device that held rigid the metatarsal. A ramp-controlled displacement of an MTS ram supplied a functional load input force to the flexor hallucis longus. The components of the resultant output force necessary to resist the input flexor hallucis longus force were transduced simultaneously by a multicomponent load cell. Subsequently, 3 progressively more extensive seasamoid resections were done: (1) distal hemiresection, (2) complete resection, and (3) resection of both sesamoids. Six specimens were tested with the medial sesamoid removed first and 6 with the lateral sesamoid removed first. Statistical analysis showed that significant decreases in the effective tendon moment arms occurred with full medial sesamoid resection, full lateral sesamoid resection, and resection of both the medial and lateral sesamoids.