Hallucal sesamoid pain: causes and surgical treatment.

Richardson EG. J Am Acad Orthop Surg 1999 Jul-Aug;7(4):270-8.

The hallucal sesamoids, although small and seemingly insignificant, play an important role in the function of the great toe by absorbing weight-bearing pressure, reducing friction, and protecting tendons. However, the functional complexity and anatomic location of these small bones make them vulnerable to injury from shear and loading forces. Injury to the hallucal sesamoids can cause incapacitating pain, which can be devastating to an athlete. Although traumatic injuries usually can be diagnosed easily, other pathologic conditions may be overlooked. Careful physical and radiologic examinations are necessary to determine the cause of pain and allow a recommendation of the optimal treatment. Surgical treatment may include partial or complete resection of the sesamoid, shaving of a prominent tibial sesamoid, or autogenous bone grafting for nonunion. Excision of both sesamoids should be avoided if possible.

Disorders of the hallux sesamoid complex: MR features.

Karasick D, Schweitzer ME. Skeletal Radiol 1998 Aug;27(8):411-8.

Numerous painful conditions can affect the first metatarsophalangeal-sesamoid joint complex. Symptoms can be of sudden or insidious onset, and be of acute or chronic duration. Although conventional radiography is recognized as the initial diagnostic procedure for these symptoms, there is often a need to proceed to MR imaging. MR imaging is sensitive and can be utilized in the investigation of the hallux sesamoid complex to differentiate soft tissue from osseous pathology. Synovitis, tendonitis, and bursitis can be distinguished from bony abnormalities such as sesamoid fracture, avascular necrosis, and osteomyelitis. An understanding of MR imaging features and techniques will result in the highest diagnostic yield. Early and accurate diagnosis of sesamoid complex disorders can guide the physician to the appropriate clinical management and prevent potentially harmful longstanding joint dysfunction.