Stress fracture of the sesamoid bone are quite uncommon. Specially the fibular sesamoid is more rarely injured. We experienced two stress fractures of the sesamoid bone of the great toe. The cause is a repeated microtrauma. The treatment consisted of compression bandaging and non-weight bearing. But when clinical sign continued, surgical treatment is necessary.

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The hallux sesamoids which are small can be the site of disabling pathology for the athletes. Bipartita sesamoid, stress fracture, and osteonecrosis have been reported in the athletes. Four young athletes, three females and one male, who presented with disorders of the hallux sesamoid were reported. All patients complained of pain during walking and running and had localized tenderness over the medial sesamoid and the pain was aggravated by dorsiflexing the great toe. Roentgenographic examination revealed separation or fragmentation of the medial sesamoid, respectively.
All patients had been kept under observation with conservative treatment consisting of pad. In one of the patients, treatment consisting of metatarsal pad did not give any relief and operation was performed.

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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.

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観血的整復術を要した母趾IP関節脱臼を経験したので報告する．症例は29歳男性である．バスケットの試合中に右足つま先から着地し受傷した．右母趾末節部は背側に転位し，IP関節の自動運動は不能であった．単純X線像ではIP関節は過伸展位で末節骨は背側に転位し，が関節内に嵌入し基節骨骨頭上に騎乗していた．骨折は認めなかった．徒手整復を試みたが，整復不能であったため，腰椎麻酔下に観血的整復術を行った．背側から進入し，内側側副靭帯を切離し，末節骨を長軸方向に牽引し，脱臼を整復した．術後1ケ月の時点で，再脱臼はなく，歩行障害は認めない．本症例はMiki分類のType 2であった．その発生機序は母趾長軸方向の負荷に加えIP関節の過伸展が強制され，plantar plateが断裂し，末節骨が背側脱臼を生じるのに伴い，も基節骨頭側に転位し，末節骨足底側と基節骨，側副靭帯からなる出口が形成され，が嵌頓したと考えられた．

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We report a case with disorder of the hallux sesamoids in which the bone disappeared very rapidly. Some of the literature is also discussed. The patient was a 27-year-old woman who complained of pain in the plantar of the head of the 1st metatarsal bone without any prior causative factors. Mild swelling and marked tenderness were also observed at the same site. On x-ray, fragmentation, mottling, and irregularity were observed at the 1st tibial sesamoid bone. She was suspected of aseptic necrosis and underwent conservative therapy. X-ray taken 1 week after onset of symptoms revealed disappearance of the bone and clinical symptoms also disappeared. Six months after the onset of symptoms she had no pain or ADL disorder.

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ジャイアントパンダの疑似母指は"パンダの親指"として有名であるが, レッサーパンダの疑似母指骨格に関する報告はほとんどみられない。本報告では2例のレッサーパンダを用いて, 主要骨格の所見ならびに手根部骨格のひとつである橈側の形態とそれに付着する筋肉などについて調べた。手根部骨格は, 他の食肉目と同様に7種の骨からできており, 中間橈側手根骨の外側には1個または2個のがみられた。この橈側は第一中手骨の2分の1程度の長さがあった。2例から橈側の発生過程を考察すると, 初めから大きなができるのではなく, 2種類の筋肉内で各々に発生, 成長したが合体して形成されると考えられた。橈側には, 短第一指外転筋と短第一指屈筋ならびに長第一指外転筋が付着していた。また, 橈側の外側を固定する靱帯としては, 手根背側靱帯があり, 手掌側を固定する靱帯として手根横断靱帯と手根手掌靱帯が認められた。レッサーパンダの橈側は, ジャイアントパンダと同じように疑似母指として機能可能な運動性を有することが示唆された。

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（目的）重度の外反母趾に対する術式であるMann法は外側軟部組織の解離と第1中足骨近位の骨切りを併用する方法であり、その際複合体の整復は重要である。我々は絶対的な位置評価が可能な足部マッピング法を用いての位置変化を検討した。（対象および方法）対象はMann法を施行した35例47足。全例女性で年齢は20-84歳（平均51歳）、術後経過観察期間は1-7年（平均2.4年）であった。術前および最終経過観察時に荷重時足部背底Ｘ線像を撮影した。足部マッピング法は、第2中足骨軸をＸ軸とし、これと第2中足骨基部との交点を原点とする2次元の座標系を用いた。これに独自のソフトを用いてに10個、第1中足骨に7個の点の座標を求めた。各座標値は第2中足骨長を100%とするパーセント数値に変換することにより手術前後における平均的な位置変化量を描出した。（結果および考察）第1中足骨は5%の短縮を認め、骨頭は16%外側に移動していた。内側は5%、外側は7%外側に移動した。すなわち第1中足骨頭は複合体とともに外側へ移動し、さらに内側上に整復されていた。の外側移動量は第1中足骨頭の移動量に比べて少なかった。本法ではMTP関節外側の軟部組織解離を行っているにもかかわらず、も外側に移動していた。これは第１中足骨での矯正が大きいため骨頭の外側移動にあわせて複合体も外側へ移動したものと思われた。

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Recently, we experienced a rare osteochondritis of the first fibular metatarsal sesamoid. A 31-year-old man complained of pain in the area of the right first metatarsal head of 2 years' duration on weight bearing and walking. There was no history of trauma or other joint involvement. Tenderness was found on the first metatarsal head of his right foot. X-rays showed irregular mottling, increased or decreased, mixed density. Technetium 99 bone scan in the patient showed a hot spot with central defect over the affected region. We excised the sesamoid in July 1983. There was an irregular crater with central necrosis in the specimen. The pathological specimen showed focal necrosis and fibrosis with capillary proliferation in the center of the sesamoid bone. On the follow-up visit the patient had no complaints.

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A 53-years-old man injured his left foot while walking, and the great toe was forced into dorsiflexion and varus. Radiographs showed dorsal-medial dislocation of the great toe distal phalanx. Several attempts at closed reduction were unsuccessful. An open reduction was therefore carried out via the dorsal approach. The capsule was ruptured and dislocation of the interphalangeal (IP) joint was observed. The sesamoid bone was found to be displaced over the proximal phalangeal head. A curved spatula was inserted between the proximal phalangeal head and the sesamoid. The flexed IP joint allowed reduction. After the reduction, the joint was unstable in the varus direction, and therefore lateral collateral ligament injury was suspected. A Kirschner wire was placed longitudinally across the IP joint for three weeks post operatively to help hold the reduction. At six weeks of follow-up radiography showed no varus instability. Three months after surgery, the patient has no complaints with almost normal function.

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Supranumerary bones and sesamoid bones can be found in the feet. We present two cases of the bone necroses of the supranumerary bone and sesamoid bone.
Case 1 was a 56 years old female. She suffered pain under the first metatarsal head of the right great toe two months before her initial appearance. The initial examination found a localized tenderness over the medial sesamoid, and roentgenographic examination slowed irregularity and fragmentation of the medial sesamoid. Removal of the sesamoid bone was performed and necrosis of the bone was diagnosed by the pathological finding.
Case 2 was a 49 years old male. He suffered from pain in his right foot 10 years ago. Though an arch support had been used for the treatment, however the pain became more severe 2 years back. Initial examination slowed a localized swelling over the right accessory navicular. Roentgenographic examination revealed irregularity and fragmentation of the accessory navicular. Removal of the accessory navicular was performed and bone necrosis was diagnosed by the pathological finding.

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今回われわれは比較的まれな母指

骨折の1例を経験した．症例は50歳女性．転倒した際，左母指を過伸展し受傷した．X線にて母指骨折を疑い，CTで確定診断を得た．明らかな合併損傷がないため，保存療法を行った．3週間の外固定の後，リハビリを開始した．受傷5ヵ月で日常生活を問題なく送れるようになった．母指骨折は単純 X 線正面像・側面像では見つけにくいため，斜位像またはCT画像の撮影が必要と考えられた．

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