Abstract
Total sesamoid excision is a powerful tool to cure recalcitrant sesamoid pain, but it has its shortcomings: excision of the lateral sesamoid led to a hallux varus, and excision of the medial sesamoid to a hallux valgus deformity in 10–20% of cases.1–5 Excision of both sesamoids may cause cock up deformity of the hallux.2,4,6,7 Each sesamoid is invested in the corresponding tendon sheath of the flexor hallucis brevis. The attachment of the tendon to the base of the proximal phalanx is crucial for the balance of the first metatarsophalangeal (MTP) joint. Injuries to these structures during total excision cause hallucal deviation. In addition, loss of preloading and elevation of the first metatarsal head due to sesamoid excision may lead to transfer metatarsalgia and loss of big toe push off.8,9
Alternative procedures have been invented to reconstruct the anatomy.10–14 The following technique of percutaneous screw fixation of sesamoid bone fractures is one of these procedures. Moreover, the skin incisions used to approach the two sesamoid bones have been connected with adverse effects: the lateral plantar approach was reported to be associated with painful plantar scar formation, and the lateral dorsal approach with accidental harm to the intrinsic hallucal muscles and interdigital nerve neuroma. The medial approach is only useful to reach the medial sesamoid bone.2–4,6 The percutaneous technique needs only a stap incision distal to the weight-bearing area of the sesamoid bone. Sterile strips are used for wound closure.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Brodsky JW, Robinson AHN, Krause JO, and Watkins D. Excision and flexor hallucis brevis reconstruction for the painful sesamoid fractures and non-unions: surgical technique, clinical results and histo-pathological findings. J Bone Joint Surg (Br) 2000 82-B:217
Grace DL. Sesamoid problems. Foot Ankle Clin 2000 5:609–627
Inge GAL and Ferguson AB. Surgery of sesamoid bones of the great toe. Arch Surg 1933 27:466–489
Richardson EG. Hallucal sesamoid pain: causes and surgical treatment. J Am Acad Orthop Surg 1999 7:270–278
Saxena A and Krisdakumtorn T. Return to activity after sesamoidectomy in athletically active individuals. Foot Ankle Int 2003 24:415–419
Jahss MH. The sesamoids of the hallux. Clin Orthop Relat Res 1981 Jun;(157):88–97
McBryde AM, Jr. and Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med 1988 7:51–60
Aper RL, Saltzman CL, and Brown TD. The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis. Foot Ankle Int 1994 15:462–470
Aper RL, Saltzman CL, and Brown TD. The effect of hallux sesamoid excision on the flexor hallucis longus moment arm. Clin Orthop Relat Res 1996 Apr;(325):209–217
Anderson RB and McBryde AM, Jr. Autogenous bone grafting of hallux sesamoid nonunions. Foot Ankle Int 1997 18:293–296
Biedert R and Hintermann B. Stress fractures of the medial great toe sesamoids in athletes. Foot Ankle Int 2003 24:137–141
Blundell CM, Nicholson P, and Blackney MW. Percutaneous screw fixation for fractures of the sesamoid bones of the hallux. J Bone Joint Surg (Br) 2002 84:1138–1141
Riley J and Selner M. Internal fixation of a displaced tibial sesamoid fracture. J Am Podiatr Med Assoc 2001 91:536–539
Rodeo SA, Warren RF, O’Brien SJ, Pavlov H, Barnes R, and Hanks GA. Diastasis of bipartite sesamoids of the first metatarsophalangeal joint. Foot Ankle 1993 14:425–434
Van Hal ME, Keene JS, Lange TA, and Clancy WG, Jr. Stress fractures of the great toe sesamoids. Am J Sports Med 1982 10:122–128
Pagenstert GI, Valderrabano V, and Hintermann B. Medial sesamoid nonunion combined with hallux valgus in athletes: a report of two cases. Foot Ankle Int 2006 27:135–140
Chisin R, Peyser A, and Milgrom C. Bone scintigraphy in the assessment of the hallucal sesamoids. Foot Ankle Int 1995 16:291–294
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Pagenstert, G.I., Valderrabano, V., Hintermann, B. (2010). Percutaneous Screw Fixation of Hallux Sesamoid Fractures. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-76608-9_60
Download citation
DOI: https://doi.org/10.1007/978-0-387-76608-9_60
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-76607-2
Online ISBN: 978-0-387-76608-9
eBook Packages: MedicineMedicine (R0)