Hallux sesamoid complex imaging: a practical diagnostic approach

Lombard, Charles; Gillet, Romain; Rauch, Aymeric; Germain, Edouard; Dodin, Gauthier; Blum, Alain; Teixeira, Pedro Augusto Gondim

doi:10.1007/s00256-020-03507-8

Cited by 6 publications

(5 citation statements)

References 42 publications

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“…Participants also recognised the value of referral for additional assessments available outside of their scope, including advanced imaging, to support diagnosis. Plain radiography and magnetic resonance imaging are currently the gold standard for imaging of sesamoiditis, followed by computed tomography as the third modality of choice [5,[19][20][21][22][23]. Podiatrists in Aotearoa New Zealand can only refer for plain radiography and ultrasound imaging of the lower limb.…”

Section: Discussionmentioning

confidence: 99%

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

Kaur

Carroll

Stewart

2023

Journal of Foot and Ankle Research

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Background Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis. Methods This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data. Results A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms. Conclusion Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient’s social factors, symptomology, and lower limb biomechanics.

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Section: Discussionmentioning

confidence: 99%

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

Kaur

Carroll

Stewart

2023

Journal of Foot and Ankle Research

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“…The medial sesamoid is larger in comparison to its lateral counterpart and therefore bears more weight and is more susceptible to pathologies. It also allows for an insertion point for the abductor hallucis tendon, whereas the lateral sesamoid attaches to the adductor hallucis muscle [ 4 ]. The intricacy of the sesamoid complex allows for increased power of plantarflexion and therefore aids in the motion of walking by enabling the movement of intrinsic foot flexors and the elevation of the first metatarsal head [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Exostosis of the Medial Sesamoid Bone

Akram¹,

Asif²,

Mangwani³

2023

JOCR

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Introduction: Exostoses in the foot and ankle are extremely rare with no current literature of exostosis of the sesamoid bone. Case Report: A middle-aged woman was referred to orthopedic foot surgeons following a long-standing issue of a painful non-fluctuant swelling beneath her left hallux with normal imaging. Repeat X-rays, with sesamoid views of the foot, were conducted due to the patient’s ongoing symptoms. The patient underwent a surgical excision and made a complete recovery. The patient is now able to comfortably walk for longer distances with no restrictions to her mobility. Conclusion: Conservative management should be initially trialed to preserve the foot’s functions and limit the risk of surgical complications. As in this case, when surgical options are explored, it is critical to preserve as much of the sesamoid bone as possible to restore and sustain function. Keywords: Orthopedics, trauma, foot, surgery, osteochondroma, exostosis.

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“…If additional evaluation of sesamoid pain is required, the most valuable imaging modality is MRI, which will be able to visualize bone edema. 18 Weight-bearing CT is valuable as well when the main objective is to identify bone and joint anatomy including the sesamoid position in relation to the intersesamoid ridge and sesamoid-first metatarsal osteoarthritis. 19…”

Section: Imagingmentioning

confidence: 99%

Assessment and Management of Atraumatic First Metatarsophalangeal Joint Pain

Drago¹,

Nazaroff²,

Britton³

et al. 2023

J Am Acad Orthop Surg

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Nontraumatic pain in the first metatarsophalangeal joint is frequent and can be debilitating. The metatarsophalangeal joint complex comprises four articulating surfaces including the first metatarsal, the proximal phalanx, and tibial and fibular sesamoids, which are all contained within a synovial capsule. The most common causes of pain are hallux valgus and hallux rigidus. However, other diagnoses, such as functional hallux limitus, sesamoiditis, gout, and inflammatory autoimmune arthritis, need to be considered as well. A systematic approach is key to accurately diagnose the source of pain, which can sometimes be the result of more than one condition. The most important clinical information to obtain is a focused history, meticulous clinical examination based on understanding the precise anatomy and biomechanics of the first metatarsophalangeal joint, and analysis of the relevant imaging. Each pathology has a different treatment algorithm, as such, understanding the pathoanatomy and biomechanics is important in forming an effective treatment plan.

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Hallux sesamoid complex imaging: a practical diagnostic approach

Cited by 6 publications

References 42 publications

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

A Rare Case of Exostosis of the Medial Sesamoid Bone

Assessment and Management of Atraumatic First Metatarsophalangeal Joint Pain

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