Hallux sesamoid complex imaging: a practical diagnostic approach
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REVIEW ARTICLE
Hallux sesamoid complex imaging: a practical diagnostic approach Charles Lombard 1 & Romain Gillet 1 & Aymeric Rauch 1 & Edouard Germain 1 & Gauthier Dodin 1 & Alain Blum 1 & Pedro Gondim Teixeira 1 Received: 17 March 2020 / Revised: 5 June 2020 / Accepted: 7 June 2020 # ISS 2020
Abstract A wide variety of pathologies can affect the hallux sesamoid complex of the foot, including traumatic, micro traumatic, degenerative, inflammatory, vascular, infectious, and neoplastic conditions. Symptoms are quite nonspecific, mainly related to pain in the plantar surface of the first metatarsal head. In this context, imaging is important for the etiologic diagnosis of hallux sesamoid complex pathology with implications in patient management. The hallux sesamoid complex has a complex anatomy, and pathologic processes of this region are poorly known of radiologists. Besides, some entities such as “sesamoiditis” remain poorly defined in the literature. Schematically, conditions affecting sesamoids will be divided into two major groups: intrinsic anomalies (sesamoid bone being the center of the pathologic process) and extrinsic anomalies (diseases secondarily involving sesamoid bones). Thus, in this article, after a review of anatomical key points and pathologies affecting the hallux sesamoid complex, a practical multimodality approach for the diagnosis of hallux sesamoid pathologies will be proposed. Keywords Hallux sesamoid complex . Fracture . Sesamoiditis . Avascular necrosis . Turf toe . Diagnostic algorithm
Introduction Forefoot pain is common and multifactorial with disorders of the first metatarsophalangeal joint (MTP) and hallux sesamoid complex (HSC) corresponding to 9% of foot and ankle injuries and 12% of great toe injuries [1]. The hallux sesamoids play an important role in great toe biomechanics by dissipating weight-bearing and shear stress in the first MTP joint. The HSC is not only susceptible to traumatic injury but can also be affected by micro traumatic, degenerative, inflammatory, vascular, infectious, and neoplastic pathologies [2–8]. Although MRI is considered the method of choice for the evaluation of HSC pathologies, it can be at times nonspecific and of difficult interpretation [7, 8]. The anatomy of the first MTP joint is complex, and pathologic processes of this region are often poorly known of radiologists. Also, the terminology of HSC pathology can be confusing with poorly defined terms such as “sesamoiditis” [3, 7–9]. As imaging could have an
* Charles Lombard [email protected] 1
Service d’imagerie Guilloz, hôpital central, CHRU de Nancy, 29 avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
impact on patient management, knowledge on the spectrum of pathologies involving the hallux sesamoids may lead to better diagnostic accuracy. Thus, in this article, the anatomical key points and pathologies affecting HSC are reviewed, and a practical diagnostic approach based on radiographs, CT imaging, and MRI is proposed.
Anatomy and biomechanics of the hallux sesa
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