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Sesamoid disorders and treatment. An update.

The anatomy, function, and disorders of the hallucal sesamoids show that the diagnosis and current concept of management are based on the individual patient's problems. The treatment should always be initiated in a conservative fashion, generally using a molded insole with an appropriate excavation to shift weight from a painful sesamoid. The advantages and disadvantages of sesamoidectomy are influenced by surgical technique. Care in handling the medial and lateral hallucal nerves is essential. Removal of both the medial and lateral sesamoids invariably leads to an intractable clawtoe deformity and is absolutely contraindicated.

Foot Deformities, Acquired↗

Sesamoiditis.

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Animals↗

Symptomatic bipartite sesamoids.

The great toe sesamoids have been well reported in the literature, in every aspect. Much has been written about the normal anatomic variation of partite metatarsophalangeal sesamoids. It is the purpose of this article to present a theory explaining the common occurrence of a symptomatic partite sesamoid. The authors believe there is a high rate of occurrence of symptomatic partite sesamoids, especially when associated with hallux abducto valgus. Presented is information concerning the internal and external structural components of a bipartite metatarsal sesamoidal joint, which may inherently lead it to symptomatology.

Humans↗

[The role of a shortening osteotomy of the first phalanges associated with soft-tissue release in the surgical treatment of hallux valgus].

The Authors report the results of 120 hallux valgus operated on 76 patients from January 1983 to June 1988. The operative procedure associated bunionectomy, tenotomy of the abductor hallucis which was resected from the base of the first phalanx and from the lateral sesamoid, shortening osteotomy of the proximal phalanx and finally adjustment of the sesamoids under the head of the first metatarsal. When there was an important metatarsus varus, a basilar osteotomy of the first metatarsal was associated (10 cases about 120). The results were appreciated functionally (pain, range of motion, easiness for putting on one's shoes) and anatomically (radiological correction of the deformity). The total result included anatomical and functional results. Anatomically, 110 feet had sesamoids perfectly adjusted (that is 92.5 per cent), 9 had an inadequate adjustment (first degree). The metatarsus varus was always improved except 3 cases; in these cases a basilar metatarsal osteotomy would have to be performed. The valgus of the big toe was corrected in 88 per cent of the cases (104 feet had a valgus lower than 15 degrees). A varus of the big toe was found in 6 cases (5 per cent). One was lower than 5 degrees; it was nevertheless included with the good results (very well endured). 5 were more than 10 degrees and were included with the poor results. Finally, we took notice of 4 degenerative changes of the first metatarso-phalangeal joint. The total results found 90 per cent of good and very good results, 6 per cent of fair results and 4 per cent of poor results.

Adolescent↗

Effect of sesamoid position on long-term results of hallux abducto valgus surgery.

Radiographic parameters for 70 patients that underwent hallux abducto valgus (HAV) surgery were evaluated with emphasis on the tibial sesamoid position. The preoperative and postoperative sesamoid positions were analyzed. Soft tissue bunionectomies, metatarsal head and base osteotomies, and first metatarsocuneiform arthrodesis are procedures that were included in this evaluation. The inadequate relocation of the sesamoids, along with other standard parameters, were then correlated with recurrence of hallux abducto valgus and metatarsus primus adductus. The surgical relocation of the sesamoid apparatus is discussed, including both an intracapsular and extracapsular release. Possible indications for fibular sesamoidectomy are suggested. Effects of sesamoid position on the long-term results of HAV surgery are presented.

Hallux Valgus↗

[A rare case].

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Adult↗

Radiologic manifestations of arthritides involving the foot.

This article has discussed the radiographic manifestations of several of the more common articular disorders affecting the foot. An organized, thoughtful approach to radiographic analysis in patients with articular diseases of the foot generally ensures accurate diagnosis. This approach requires knowledge of the classic morphologic features of each articular disease as well as its typical distribution in the foot. Using knowledge of radiologic-pathologic correlation and the target area approach to disease, the physician can make an accurate diagnosis in most instances.

Arthritis↗

Chondromalacia of the fabella: a case report.

A 46-year-old man suffered from chondromalacia of the fabella after minor trauma to the back of the knee. The condition was misdiagnosed initially as fasciitis, tendinitis, a Baker's cyst and a herniated lumbar intervertebral disc. Pathognomonic signs were pain behind the lateral femoral condyle on palpation and compression of the fabella and also on passive extension of the knee. Conservative management was unsuccessful. Excision of the fabella gave quick and lasting relief.

Cartilage Diseases↗

Congenital absence of the tibial sesamoid: a report of two cases.

Congenital absence of the tibial sesamoid is a rare condition that has been infrequently reported in the podiatric literature. Two cases of congenital absence of the tibial sesamoid are presented with an associated hallux abducto valgus deformity. The role of a weakened medial flexor hallucis brevis tendon as a predisposing factor leading to a hallux abducto valgus deformity is discussed.

Adult↗