Avascular Necrosis of the Sesamoids

Bartosiak, Kimberly; McCormick, Jeremy J.

doi:10.1016/j.fcl.2018.09.004

Cited by 21 publications

(18 citation statements)

References 21 publications

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“…Pathology of the hallux sesamoids, including fracture, stress fracture, nonunion, osteonecrosis/avascular necrosis, chondromalacia, and sesamoiditis (eg, from mechanical overload), can cause persistent, activity-limiting pain. 3,6 Potential conservative treatments include immobilization in a cast or boot, offloading with metatarsal pads or orthotics, hallux dorsiflexion restriction with a carbon fiber foot plate, nonsteroidal anti-inflammatory medications, and intra-articular corticosteroid injections (eg, for metatarsal-sesamoid joint chondromalacia), among other modalities. 3,6,15 When conservative treatment fails, operative intervention in the form of sesamoidectomy may be indicated.…”

Section: Introductionmentioning

confidence: 99%

“…3,6 Potential conservative treatments include immobilization in a cast or boot, offloading with metatarsal pads or orthotics, hallux dorsiflexion restriction with a carbon fiber foot plate, nonsteroidal anti-inflammatory medications, and intra-articular corticosteroid injections (eg, for metatarsal-sesamoid joint chondromalacia), among other modalities. 3,6,15 When conservative treatment fails, operative intervention in the form of sesamoidectomy may be indicated. 5,8,9 Normally, the hallux sesamoids function to increase the mechanical advantage of the flexor hallucis brevis tendons, protect the flexor hallucis longus tendon gliding between them, and serve as the center of the insertional complex of the plantar fascia into the hallux.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach

et al. 2019

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Background: The purpose of this study was to evaluate patients for intermediate-term pain relief, functional outcome, and changes in hallux alignment following isolated, complete fibular sesamoidectomy via a plantar approach for sesamoid-related pain recalcitrant to conservative treatment. Methods: A retrospective query of a tertiary referral center administrative database was performed using the Current Procedural Terminology code 28135 for sesamoidectomy between 2005 and 2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted to return for an office visit. The primary outcome measure was change in visual analog pain score at final follow-up. Secondary measures included satisfaction, hallux flexion strength, hallux alignment, pedobarographic assessment, and postoperative functional outcome scores. Patients who met the 2-year clinical or radiographic follow-up minimum were included. Ninety fibular sesamoidectomies were identified. Thirty-six sesamoidectomies met inclusion criteria (median 60-month follow-up). The average patient was 36 years old and underwent sesamoidectomy 1.1 years after initial diagnosis. Results: Median visual analog scale scores improved 5 (6 to 1) points at final follow-up ( P < .001). Final postoperative mean hallux valgus angle did not differ from preoperative values (10.5 degrees/8.5 degrees, P = .12); similarly, the intermetatarsal angle did not differ (8.0 degrees/7.9 degrees, P = .53). Eighty-eight percent of patients would have surgery again and 70% were “very satisfied” with their result. Hallux flexion strength (mean 14.7 pounds) did not differ relative to the contralateral foot (mean 16.1 pounds) ( P = .23). Among the full 92 case cohort, 3 patients underwent 4 known reoperations. Conclusion: Fibular sesamoidectomy effectively provided pain relief (median 5-year follow-up) for patients with sesamoid pathology without affecting hallux alignment. Level of Evidence: Level IV, retrospective case series.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach

et al. 2019

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“…Hallux valgus is a common disease in foot and ankle surgery, which is a kind of foot compound deformity in which the metatarsal toe tilts outward and exceeds the normal physiological angle [9][10][11][12] . It is characterized by the adduction of the rst metatarsal bone, hallux valgus deformity and subluxation of the rst metatarsophalangeal joint in severe cases [13] .…”

Section: The Incidence Of Hallux Valgusmentioning

confidence: 99%

“…In 1990, the National Institutes of Health calculated that the incidence of hallux valgus was 5.1% [17] . There are more females than males, and the ratio of male to female is 1: 4.63 [18][19][20] . In our study, the average age of hallux valgus patients was (43.4 ± 2.1) years old, the youngest patient age was 14 years old, and the male to female ratio was 1: 6.14 (42 / 258).…”

Section: The Incidence Of Hallux Valgusmentioning

confidence: 99%

Correlative Study Between the Sesamoid Bones under the Head of the First Metatarsal and the Development of Hallux Valgus Determined with Radiographs

Li¹,

Liu²,

Wang³

2021

Preprint

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Objective. To study the correlative between the sesamoid bones under the head of the first metatarsal and the development of hallux valgus determined with radiographs.Methods.The measurements were performed on the X-ray of 300 normal feet and 300 cases of hallux valgus. The following parameters were measured: hallux valgus angle(HVA); the first-second intermetatarsal angle(IMA) between the axes of the first and second metatarsal;the length of the second metatarsal（CD）;the position of tibial sesamoid(TSP ) measured the percent formed between the tibial sesamoid and the centreline of the first metatarsal;the position of fibular sesamoid(FSP) measured tangent value between fibular sesamoid bone and lateral cortex of first metatarsal bone ; the absolute distances (AB) from the centre of the tibial sesamoid to the long axis of the second metatarsal, the absolute distances (EF) from the centre of the fibular sesamoid to the long axis of the second metatarsal and the absolute distance (GH) from the centre of the tibial sesamoid to the centre of the fibular sesamoid. Then calculate the ratio of AB to CD (K1), EF to CD (K2) and GH to CD (K3). Results.HVA moderately positively correlates with TSP and moderately negatively correlates with FSP in subjects with HVA ≥ 20°. HVA and FSP are strongly negatively correlated in the hallux valgus group. Conclusion.The dislocation of sesamoid bone under the first metatarsal head is an important pathological factor leading to valgus. HVA is positively correlated with TSP and negatively correlated with FSP.

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“…If undetected, sesamoid fractures may disrupt surrounding blood supply, leading to delayed union, nonunion or avascular necrosis (AVN) of the sesamoids. 6 Cross-sectional imaging with Computed Tomography (CT) or Magnetic Resonance Imaging plays a crucial role in confirming a sesamoid injury.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous medial and lateral hallucal sesamoid fractures in a basketball player mimicking bipartite sesamoid condition

Rachakondaa

Kollimarlab

Iyengar

2022

Journal of Clinical Orthopaedics and Trauma

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Simultaneous fractures of the medial and lateral hallucal sesamoids from sports injuries are an extremely uncommon occurrences, with only one case reported in a hurdler. We describe an unusual injury in a basketball player resulting in simultaneous fractures of the medial and lateral hallucal sesamoid bones, a presentation, which we believe has not been reported before in the literature. With a growing interest in sports, the frequency of such injuries will undoubtedly rise. We highlight the clinical characteristics, biomechanical mechanism, role of complementary cross-sectional imaging in the diagnosis of hallucal sesamoid fractures. This case report emphasizes the need of high index of suspicion in reaching conclusive diagnosis of such rare injuries to prevent long term complications such as avascular necrosis or non-union and facilitate early return to sporting activities.

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Avascular Necrosis of the Sesamoids

Cited by 21 publications

References 21 publications

Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach

Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach

Correlative Study Between the Sesamoid Bones under the Head of the First Metatarsal and the Development of Hallux Valgus Determined with Radiographs

Simultaneous medial and lateral hallucal sesamoid fractures in a basketball player mimicking bipartite sesamoid condition

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