Sesamoiditis

Abstract: The seemingly innocuous tiny sesamoids play an important role in the function and pathomechanics of the hallux. The recent active participation of people of all ages in jogging and long-distance running, activities introducing repetitive stressful forces on the forefoot, induces sesamoiditis. Bones normally asymptomatic, such as the sesamoids, require renewed interest in embryology, anatomy, congenital variations, infection, osteochondritis, trauma and effective treatment.

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.

Abstract: During the past twenty years there have appeared in the literature numerous papers relating to the sesamoid bones of the great toe and their clinical significance. One is impressed, in reading most of these articles, by the uncertainty regarding the embryology, anatomy and function of these small structures, and by the number of disputed points relative to their surgical pathology and treatment. In view of this uncertainty, and because no thorough survey of the literature has appeared, we report this study made in connection with the follow-up investigation of our own cases. Our plan is to review the literature, to cite the results of our own anatomic and pathologic studies and finally to report a series of cases in which sesamoidectomy was performed for the relief of pain. HISTORICAL SUMMARY Not always have the sesamoid bones of the great toe played a role of such relative insignificance as they play

Abstract: In the U.S., greater than half of boys and one quarter of girls in the 8- to 16-yr-old age range are engaged in some type of competitive, scholastic, organized sport during the school year. Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. Foot and ankle problems, in particular, are the second most common musculoskeletal problem facing primary care physicians in children under 10 yr of age next to acute injury. This report focuses on foot and ankle problems, trauma, and overuse in the young athletic population. Guidelines are given for both conservative and surgical management. Specific problems addressed include pes planus, tarsal coalition, adolescent bunion, os trigonum, accessory navicular, physeal fractures, sprains, peroneal tendon subluxation, metatarsal fractures, sesamoid fractures, turf toe, stress fractures, tendonitis, osteochondritis dissecans, ankle impingement, bursitis, Haglund's deformity, sesamoiditis, plantar fasciitis, apophysitis, osteochondroses, cuboid syndrome, and reflex sympathetic dystrophy. An extensive review of the literature is performed and presented in combination with the extensive experience of a well-established sports medicine clinic at the Boston Children's Hospital.