Disorders of the Hallux Sesamoids

Abstract

We report four cases five toes with hallux sesamoid lesions which were treated using sesamoidectomy. In this report, the surgical technique for such disorders and the differentiation between osteonecrosis and fracture of the sesamoids are discussed.
All toes had the same histological findings consisting of necrotic bone and fibrocartilaginous material making it difficult to discriminate histologically between osteonecrosis and fracture. We used clinical criteria to diagnose sesamoid fracture in which subjects recalled any strenuous activity or minor trauma due to sesamoid pain. Finally two fractures and three osteonecroses were diagnosed, treated and followed.
At surgery we recommend a medial midline incision and plantar approach to the sesamoid without a medial capsular incision as this method may help to prevent hallux deformity and reduce the abutting of the digital nerve by the sesamoid.