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PubMedDate not supplied

Orthotic treatment of sesamoid pain.

The cause of pain and tenderness beneath the first metatarsal in an athlete is often very difficult to determine. When the symptoms originate from the sesamoid bone, exact diagnosis of the pathologic process may not be necessary in order to institute effective treatment. In this retrospective study, 8 of 10 athletes with this problem were successfully treated with custom-fitted orthoses which relieve sesamoid pain. The major benefit of this method of treatment is that it enables an athlete to continue participation without loss of valuable practice and competition time.

Adolescent↗
PubMedDate not supplied

Distribution of the metatarsophalangeal sesamoids in Turkish subjects.

No statistically significant pattern of metatarsophalangeal sesamoid distribution has been reported in the literature in relation to genetic pool or group, unilaterality or bilaterality, or sesamoid division. A study was undertaken to evaluate the presence and distribution of the metatarsophalangeal sesamoid bones of the foot in Turkish subjects. A total of 602 foot radiographs from 371 patients without forefoot complaints other than those of the hallux were included in the study. Absence or hypoplasia of the first-ray sesamoids was seen on 0.7% of the radiographs, and second-, third-, fourth-, and fifth-ray sesamoids were present on 2.8%, 0.5%, 1.0%, and 15.1% of the radiographs, respectively. Fifth-ray sesamoids were more prevalent in men (odds ratio, 2.71; 95% confidence interval, 1.52-4.84). The frequency of a normal foot profile (two sesamoids in the first ray) was 83.2%. Divisions of the sesamoids were seen on 4.0% of the radiographs at the first ray and on 20.9% at the fifth ray. Distribution and division of sesamoids were predominantly bilateral (kappa = 0.91, 0.91, and 0.95 for the first, second, and fifth digits, respectively; P < .001).

Adult↗
PubMed1989

Pathophysiology of navicular syndrome.

Navicular syndrome is a degenerative disorder of the distal half of the flexor surface of the proximal sesamoid bone that is predisposed by faulty foot conformation. In horses that become symptomatic, the faulty conformation results in sustained application of nonphysiologic pressure by the deep digital flexor tendon against the flexor cortex of the bone. This force stimulates an intense bone remodeling response in order to attenuate the pressure. An unfortunate sequela of this response is active hyperemia and edema formation in the medullary cavity of the bone. The edema is organized by fibrous tissue resulting in venous entrapment, venous hypertension, vascular bone pain, and the onset of clinical signs.

Animals↗
PubMedDate not supplied

The hallucal interphalangeal sesamoid.

The hallucal interphalangeal sesamoid is considered by some to represent an anatomical rarity that possesses little clinical significance. However, the location of this seemingly innocuous sesamoid bone directly inferior to the hallucal interphalangeal joint of the hallux is associated with the development of several important anatomical, biomechanical, and clinical pathologies. The authors present a review of the literature regarding the location, shape, ontogeny, and surgical management of the hallucal interphalangeal sesamoid. Additionally, the authors discuss the detrimental effect the hallucal interphalangeal sesamoid has on the biomechanical functions of the first metatarsophalangeal and hallucal interphalangeal joints.

Hallux↗
PubMed1991

Posttraumatic proximal migration of the first metatarsophalangeal joint sesamoids: a report of four cases.

Four cases are presented with plantar plate injury to the first metatarsophalangeal (MTP) joint and proximal retraction of the sesamoids by the flexor hallucis brevis. No history of dislocation occurred in any patient, although two had associated fractures of a sesamoid bone. Clinical and radiographic aids to the diagnosis are discussed. Clinical findings included diffuse pain beneath the first MTP joint and pain with extremes of joint motion in all patients. The anterior-posterior (AP) radiographic technique was the most helpful in determining the proximal migration of the sesamoids. By taking the AP view with both feet on the cassette and by centering the beam perpendicular to it, the diagnosis of plantar plate disruption can easily be made. Initial treatment of this disorder was nonoperative using a stiff soled shoe. With conservative treatment, two of the patients returned to preinjury activities. One patient required sesamoidectomy for resistant pain, and the final patient is still unable to return to his preinjury job requiring standing and heavy lifting.

Adult↗
PubMed2002

A study on the pathogenesis of equine sesamoiditis: the effects of experimental occlusion of the sesamoidean artery.

In this study the potential role of circulatory disturbances in the pathogenesis of sesamoiditis was investigated by studying the clinical and histological effects of experimental occlusion of the sesamoidean artery, which is the main nutrient artery of the proximal sesamoid bone (PSB). For this purpose, five adult Dutch Warmblood horses were used in which the sesamoidean artery was occluded with polyvinyl alcohol foam particles. Bone labelling was carried out with oxytetracycline and calcein. All animal were checked clinically three times a week and radiographically at days 14, 21, 28 and 35. At day 35 the animals were killed and the fetlock was dissected and macroscopically evaluated. The PSBs were isolated and radiographed and the soft tissues adjacent to the abaxial side of the PSBs were histologically examined [routine histology and for the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP)]. The PSBs were divided into bony slices which were radiographed and evaluated histologically (routine, SP, CGRP, fluorescence). All horses showed a slight lameness that gradually diminished. Radiographically enlarged vascular channels were seen in only one horse. Histological data showed that on average 60% (range 37-89%) of the total area had been deprived of vascularization. In two horses an increase in the extent of the arterial network from the basal side of the PSB was seen. Only in the horse with the greatest extent of occlusion were bone necrosis and a reactively increased uptake of fluorochromes adjacent to the occluded arteries found. Bone density did not change. The distribution of neuropeptides in the surrounding soft tissues was not affected by the occlusion. From this study, it can be concluded that a large part of the arterial supply to the PSB can be interrupted without provoking histological and/or radiographic changes that are consistent with clinical sesamoiditis. Therefore, it seems very improbable that circulatory disturbances are a primary aetiopathogenic factor in the disease.

Animals↗
PubMedDate not supplied

Hallucal sesamoid osteonecrosis: an overlooked cause of forefoot pain.

Four cases of osteonecrosis of hallucal sesamoids are reported here. Surgical excision of necrotic sesamoid tissue yielded satisfactory results, with the patients reporting no residual pain. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistent forefoot pain.

Adult↗
PubMed1987

["Sesamoiditis" of the metatarsophalangeal joint].

Reference is made to three of the authors' own cases and to relevant literature in an account of clinical manifestation, diagnosis, and therapy of osteochondrosis and osteomyelitis of the first metatarsal sesamoid bone. Eighty per cent of the incidence are related to the age groups between 13 and 22 years. The disease is probably based on aseptic ischaemic necrosis.

Combined Modality Therapy↗
PubMedDate not supplied

Magnetic resonance imaging of the equine metacarpophalangeal joint: three-dimensional reconstruction and anatomic analysis.

Magnetic resonance imaging was used to examine the equine metacarpophalangeal joint. Thirty-two saggital images generated by partial volume imaging were transferred to a computer for three-dimensional reconstruction and analysis. All the tissues constituting the metacarpophalangeal joint were readily identified. The most significant increase finding regarded the soft tissues on the palmar aspect of the metacarpophalangeal joint and their interactions with the proximal sesamoid bones. The equine metacarpophalangeal joint has not previously been evaluated using 3-dimensional imaging software.

Animals↗
PubMed1990

Chronic painful sesamoids of the thumb.

In patients with persistent localized pain at the level of a sesamoid bone of the thumb not obviously related to trauma, sesamoidectomy gives excellent results. Often no X-ray or histological abnormalities are found, leaving the origin of pain problems still unsolved.

Adult↗
PubMedDate not supplied

Os peroneum fracture with sural nerve entrapment neuritis.

The os peroneum is a sesamoid bone contained in the peroneus longus tendon. When present, it usually is located at the plantar lateral aspect of the cuboid. The author presents a case of os peroneum fracture causing sural nerve entrapment. A review of literature is also presented.

Adult↗
PubMed2003

The fibrocartilaginous sesamoid: a cause of size and signal variation in the normal distal posterior tibial tendon.

The aim of this study was to investigate the presence of fibrocartilage within the distal posterior tibial tendon (PTT) before its division correlating with size and signal variation on MR images through a radio-anatomic and pathologic study. Eight fresh cadaveric feet underwent MR imaging were cut into 4-mm slices in the axial plane. The PTT specimens were harvested at the tendon distal portion before its division and sent to pathology. Thirty-three asymptomatic subjects underwent axial double-echo turbo-spin-echo MR imaging. Proximal and distal PTT signal and diameter were evaluated. In cadavers, every PTT flared distally. Intratendinous fibrocartilage and ossified sesamoid were found in, respectively, 87.5 and 12.5% of the cases. Distal PTT flaring was demonstrated in 100% of the asymptomatic subjects (mean diameter 8 mm). An intratendinous high signal intensity on proton-density-weighted images and sesamoid bone were evidenced in, respectively, 36 and 33% of the cases. Proximally, PTT presented a 4-mm mean diameter and was hypointense in 100% of the cases. Only one accessory navicular bone was detected. Laterally off-centered increased intratendinous signal intensity as well as PTT distal widening with otherwise normal MR imaging features are related to an intratendinous fibrocartilage.

Adult↗
PubMed1984

Developmental pathogenesis of chromosome disorders: report on two newly recognized signs of Down syndrome.

Testing the hypothesis of amplified developmental instability in autosomal trisomies as proposed by Shapiro we predicted and found an increased frequency of symphalangies in the toes of patients with Down syndrome. In our X-ray study of the feet of 71 adults with trisomy 21 we also detected a greater than normal number of sesamoid bones. A corollary to Shapiro's hypothesis is a dependence on ethnic origin of the frequency of symptoms in Down syndrome. Compared to data from Europe, toe symphalangies are more prevalent in Japan. We predict this anomaly to occur even more often in Japanese patients with trisomy 21.

Adult↗
PubMed1987

Knee dysfunction secondary to dislocation of the fabella.

The fabella, a sesamoid bone in the lateral head of the gastrocnemius muscle occurring in 10% to 30% of individuals, is rarely considered a possible cause of knee dysfunction. When noted, the fabella is occasionally mistaken radiographically for an intraarticular ossified fragment; however, symptomatic conditions of the fabella have been well documented in the literature. This is a report of symptomatic dislocation of an enlarged fabella in a 37-year-old man. In a review of the literature of various lesions of the fabella, disability related to dislocation seems not to have been previously reported.

Adult↗
PubMedDate not supplied

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

OBJECTIVE: To develop a technique for arthroscopic excision of apical sesamoid fracture fragments using electrocautery probes. ANIMALS OR SAMPLE POPULATION: A total of 18 Standardbred horses. METHODS: 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. RESULTS: 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. CONCLUSION: Arthroscopic excision of apical sesamoid fracture fragments can be accomplished arthroscopically using electrocautery probes. CLINICAL RELEVANCE: Arthroscopic electrosurgery is an efficient and safe alternative for intra-articular dissection in horses.

Animals↗
PubMed1986

Kinematics of the first metatarsophalangeal joint.

The kinematics of both the first metatarsophalangeal joint and the articulation of the hallux sesamoid bones with the metatarsal head were investigated with fifteen fresh-frozen below-the-knee amputation specimens using a radiographic technique. Six feet were of normal structural anatomy, six displayed hallux valgus, and three had hallux rigidus. Normal specimens demonstrated an average total range of motion in the sagittal plane of 111 degrees, with about 76 degrees of dorsiflexion and 34 degrees of plantar flexion. The abnormal specimens revealed a decreased total arc of motion, with a limitation of plantar flexion in feet with hallux valgus and a loss of dorsiflexion in feet with hallux rigidus. Motion analysis of the normal metatarsophalangeal joints demonstrated minimum scattering of instant centers of rotation. This was in contrast to the diseased articulations, which displayed markedly displaced instant centers of rotation located eccentrically about the metatarsal head. Surface motion in the normal joints was characterized as tangential sliding from maximum plantar flexion to moderate dorsiflexion, with some compression at maximum dorsiflexion. The feet with hallux valgus and the feet with hallux rigidus displayed distinctive patterns of distraction and jamming throughout specific portions of the range of motion in the sagittal plane. Motion of the metatarsophalangeal joint in the transverse plane concomitant with motion in the sagittal plane, which has been hypothesized by other investigators, was confirmed and quantified in this study. The feet with hallux rigidus displayed a reduction in this motion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗