Despite the fact that the hallucal sesamoids play a crucial role in forefoot mechanics, disorders resulting from pathology of these structures are often overlooked or misdiagnosed. Avascular necrosis (AVN) of the hallucal sesamoids is a rare condition that must be differentiated from other pathologies, such as fractures, pseudarthrosis or osteomyelitis. We report on two patients with AVN of the fibular (lateral) hallucal sesamoid (Morbus Renander). In both patients the necrotic part of the fibular sesamoid was excised surgically after failed conservative therapy. The followup was 29 and 26 months. The clinical and radiological results showed a complete relief of pain in both patients without any complications or forefoot deformities. Recent literature and own experiences support non-operative initial management including anti-inflammatory medications, shoe modification and temporary limited weight bearing. If symptoms persist, surgical treatment with excision of the necrotic part of the sesamoid may be an alternative. Consideration by the surgeon should be given to protecting the neurovascular bundle and reattaching intrinsic tendons and ligaments if necessary. Satisfying results can be achieved by surgical removal.

This study indicates that lateral ankle pain may be due to isolated acute or chronic peroneus longus tendon tears. Thorough clinical and radiological diagnosis is necessary to detect this uncommon injury in time. Patients with acute onset of symptoms and short time between symptoms and diagnosis tend to fare better than the chronic tears and delayed diagnosis. Surgical intervention yields successful and predictable results.

Between 2002 and 2011, the technique was used in 35 children (68 feet; mean age 10 years). Complications were peroneal spasms, overcorrections, wound healing problems and local tenderness. Tarsometatarsal and calcaneal pitch angle improved significantly. The procedure is a reliable method for the correction of flexible juvenile flatfeet allowing "growth adjustment" of the subtalar joint.

SSC and reporting near mistakes enables a comprehensive failure analysis helping to avoid future complications and improve medical quality.