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Absent medial sesamoid?!?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by samuzz, Jan 20, 2010.

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  1. samuzz

    samuzz Member


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    I had a patient today that we have found to be missing a medial sesamoid. I have never heard of this before, and was wondering if anyone out there has seen this previosuly.

    She presented with pain aound the medial sesamoid and tenderness with palpation around the medial/distal aspect of the right 1st metatarsal.

    She has been referred to me by the sports dr and physio after they were not sure what to do. MRI has confirmed right abductor hallucis strain, inertmetatarsal bursitis (all IM spaces) and an absent medial sesamoid.

    I am aware of the increased risk of HAV with this sesamoid being absent. I thought I'd post on here to see if there was anything else I should be looking out for now and in the future for this patient. She is a young (28yr old), athletic person competing in aust rules football and triathlon.

    Already there is redcution of non-weight bearing 1st MPJ ROM to 20-25 degress of dorsiflexion. No HAV progress noted, 1st Ray position & stiffness and foot function are within normal limits.

    Any info regarding this condition would be appreciated.

    Scott
     
  2. Paul Bowles

    Paul Bowles Well-Known Member

    Scott interesting case.

    Is her clinical pain presentation the abductor issue? i.e. does she had fluid around the abductor tendon?

    I have worked with all sorts of long distance type athletes over the years and have routinely sent some fractured sesamoids off for surgical removal. The patient usually responds quite well on return to excercise (some with orthoses some not) however you have to watch for the usual suspects such as fib sesamoid overload/symptoms and the sequelae that come with along with removal.

    What is her loaded 1st MTPJ ROM like? I would also be interested in the intermetatarsal bursistis (which is actually really easy to treat with guided corticosteroid injections) and its relationship to any functional hallux limitus issues she is having.
     
  3. Hi Scott here is some info for you.

    The above looked good but could only find abstract maybe someone will post the full copy or you can buy it if you think it something for you.

    Have this full text for you as well. Hope that helps.
     

    Attached Files:

  4. jenhong007

    jenhong007 Welcome New Poster

    Hi there, I am missing a medial sesamoid in my left foot too! It has been a life-long problem since I am a dancer (modern, not ballet... that would be a real problem). I found out a couple of years ago after getting an x-ray. Anyway, just thought I'd post as perhaps it's not as rare as I thought to have a missing bone. On a side note, I found out that my older sister has an accessory navicular bone in her left foot. Perhaps she got my missing bone?

    My sister is a dancer as well. I was a performing modern dancer in the Pacific Northwest, she was a former dance/cheerleader at Northwestern.
     
  5. BEN-HUR

    BEN-HUR Well-Known Member

  6. Mart

    Mart Well-Known Member

    I recall seeing a couple of patients over past several years with persistent pain which I felt associated with congenital absence of a hallux sesamoid.

    Both presented with activity related metatarsalgia at 1st metatarsal head. Other than absent sesamoid (confirmed with imaging) and point of maximum tenderness at the sesamoid present there was nothing remarkable about physical exam, foot structure, static alignment or walking gait. Both had sonographically visible edema within plantar fibro-fatty pad at remaining sesamoid. My assumption for both was of compression overload which might be explained by increased localised pressure associated with altered geometry of weight-bearing bone. Both had immediate and complete resolution of pain which I attributed using a foot orthoses with cutaway window to offload 1st metatarsal head.

    If you are still having foot pain try and find someone who can properly diagnose its cause. Good luck

    Cheers

    Martin

    Foot and Ankle Clinic
    1365 Grant Ave.
    Winnipeg Manitoba R3M 1Z8
    phone [204] 837 FOOT (3668)
    fax [204] 774 9918
    www.winnipegfootclinic.com
     
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