Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology

Abstract

Sesamoids and accessory ossicles seen in the foot vary widely in their prevalence and appearance. Occasionally, these bones may be associated with painful syndromes, due to various pathologies, including trauma, infection, inflammation, degeneration and others. However, symptomatic accessory and sesamoid bones are rare, and search for additional pathology should be performed. Although the clinical significance of these osseous structures is probably minor, clinicians very commonly ask about these bones, which may originate an unnecessary work-up. Therefore, knowledge of their presence and morphological variations is important to prevent misinterpreting them as fractures—a common error. Finally, it may be very difficult to distinguish between incidental variants and truly symptomatic ones. Radiological studies provide insight regarding the presence and pathology involving these bones. This review describes an overview of the anatomy of sesamoids and accessory ossicles in the foot, and provides a pictorial review of their pathological conditions, including trauma, sesamoiditis, osteomyelitis, osteoarthritis and pain syndromes. Radiological studies including radiography, ultrasound, scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI) provide useful information which should be used in concert with clinical findings to guide patient management.Teaching points• Sesamoids and accessory ossicles seen in the foot vary widely in their prevalence and appearance.• Pathology of these bones includes trauma, sesamoiditis, infection, osteoarthritis and pain syndromes.• Radiography, ultrasound, scintigraphy, CT and MRI provide information regarding the pathology of these bones.

Epidemiological profile of sesamoid disorders of the first metatarsophalangeal joint

“…Outro fator consensual na literatura é a prática de atividade esportiva afetando a primeira articulação MTTF (7,(17)(18)(19) . Conforme os nossos resultados, 65,7% praticava atividade fí-sica com regularidade e com um mínimo de 1 hora de exercícios diários.…”

“…Mas há consenso de que tais desordens são mais frequentes nos atletas profissionais devido ao estresse repetitivo sobre a primeira articulação metatarsofalân gica (17) . Atividades de dança -principalmente o balletcorrida, jogging e até mesmo o uso abusivo de sapatos de salto alto, também foram postulados como fatores de risco para sesamoidite (10,(17)(18)(19) . Devido à anatomia complexa e às numerosas estruturas sensíveis à dor na região da primeira articulação MTTF, um diagnóstico diferencial pode ser um desafio (13) .…”

An Unusual Os Trigonum Syndrome Case Secondary to Car Accident: A Case Report

“…Often as its name suggests, the shape is triangular, with anterior, inferior, and posterior surfaces; however, it can be oval or rounded and variable in size (6,7). Most patients with an os trigonum are actually asymptomatic and present with just incidentally abnormal radiographic findings in 7% of the population (1).…”

A rare case of symptomatic os supranaviculare in a sportsman

“…Accessory ossicles can be affected by trauma, infection, degenerative disease and osteonecrosis 11 . The most common accessory ossicles were accessory navicular (11.7%), os peroneum (4.7%), os trigonum (2.3%), os supranaviculare (1.6%), os vesalianum (0.4%), os supratalare (0.2%) and os intermetatarseum (0.2%) 3 .…”