Sesamoid reduction and recurrence of HAV

NewsBot · Jul 2, 2009

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Postoperative Incomplete Reduction of the Sesamoids as a Risk Factor for Recurrence of Hallux Valgus
Ryuzo Okuda, Mitsuo Kino****a, To****o Yasuda, Tsuyoshi Jotoku, Naoshi Kitano, and Hiroaki Shima
The Journal of Bone and Joint Surgery (American). 2009;91:1637-1645.

Background: It is unknown whether postoperative incomplete reduction of the sesamoids is a risk factor for the recurrence of hallux valgus. The purpose of the present study was to clarify the relationship between the postoperative relative sesamoid position and the recurrence of hallux valgus.
Methods: Dorsoplantar weight-bearing radiographs of sixty normal feet (the control group) and sixty-five feet with hallux valgus (the hallux valgus group) in a study of adult women were reviewed. The feet in the hallux valgus group were treated with a proximal metatarsal osteotomy, and the radiographs were assessed preoperatively, at the early follow-up interval (at a mean of 3.1 months), and at the most recent follow-up interval (at a mean of forty-five months). The position of the medial sesamoid was classified with a grading system ranging from I through VII as described by Hardy and Clapham. In the feet with hallux valgus, we defined a grade of IV or less as the normal position of the medial sesamoid (the normal-position group) and grade V or greater as lateral displacement of the sesamoid (the displacement group).

Results: Fifty feet (83%) in the control group were classified as grade IV or less and ten, as grade V. All feet in the hallux valgus group were classified as grade V or greater preoperatively, forty-eight feet (74%) were classified as grade IV or less at the early follow-up evaluation, and forty-two feet (65%) were classified as grade IV or less at the most recent follow-up evaluation. The average hallux valgus angle in the hallux valgus group was 38.3° (range, 25° to 60°) preoperatively, 11.9° (range, 4° to 28°) at the time of the early follow-up, and 13.9° (range, 0° to 33°) at the time of the most recent follow-up. There was no significant difference in the average hallux valgus angle between the early and most recent follow-up evaluations in the feet that were considered to be in the normal-position group at the time of the early follow-up (p = 0.084). In the feet that were considered to be in the displacement group at the time of the early follow-up, the average hallux valgus angle at the time of the most recent follow-up was significantly greater than that at the time of the early follow-up (19.5° ± 8.4° compared with 15.0° ± 5.8°) (p = 0.0082). The feet that were in the displacement group at the time of the early follow-up had a greater risk of having recurrence of the hallux valgus at that time than did those in the normal-position group (odds ratio, 10.0; 95% confidence interval, 2.75 to 36.33).

Conclusions: Postoperative incomplete reduction of the sesamoids can be a risk factor for the recurrence of hallux valgus. The identification of incomplete reduction of the sesamoids intraoperatively may allow modification of surgical procedures and improvement of the surgical results.
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NewsBot · Jul 8, 2014

Measuring Sesamoid Position in Hallux Valgus
When Is the Sesamoid Axial View Necessary?
Dominic Catanese, DPM FACFAS; Daniel Popowitz, DPM, AACFAS; Aharon Z. Gladstein, MD
Foot Ankle Spec July 7, 2014

Measuring tibial sesamoid position is an important component of the preoperative radiographic evaluation of hallux valgus as it helps guide the surgeon in surgical selection. Tibial sesamoid position is typically measured on an anteroposterior (AP) radiograph on a scale from 1 to 7 as described by Hardy and Clapham. Some authors have advocated measuring the position on the sesamoid axial view, noting that the AP and axial views often yield different measurements. There is no consensus as to which view is more helpful in guiding the surgeon’s surgical decision. Weightbearing radiographs of 99 feet in patients with a clinical diagnosis of hallux valgus were retrospectively reviewed. Tibial sesamoid position was measured on the AP view using the 7-point scale of Hardy and Clapham. Tibial sesamoid position was also measured on the axial radiograph. Cohen’s kappa statistic was used to assess agreement of measurements obtained on the 2 views. There was poor agreement of the AP and axial views, with a kappa of 0.31. In our analysis of the data, it was determined that the lack of agreement was due mainly to X-rays showing tibial sesamoid positions of 4 and 5. A subgroup analysis of all X-rays with tibial sesamoids in positions other than 4 or 5 showed excellent agreement, with a kappa of 0.95. Anteroposterior and sesamoid axial views of feet with hallux valgus show excellent agreement in patients with the tibial sesamoid in positions other than 4 or 5. If the tibial sesamoid has a position of 4 or 5 on the AP, an axial view may be warranted to further understand the extent of deformity.
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NewsBot · Mar 27, 2015

A New Measure of Tibial Sesamoid Position in Hallux Valgus in Relation to the Coronal Rotation of the First Metatarsal in CT Scans
Yejeong De Geer, Jin-su Kim, Ki-won Young, Reza Naraghi, Hunki Cho, Sang-young Lee
Foot & Ankle International March 26, 2015

Background: We aimed to find a new radiographic measurement for evaluating first metatarsal pronation and sesamoid position in hallux valgus (HV) deformity.
Methods: Data from a clinical study of 19 control patients (19 feet) with no HV deformity were compared with preoperative data of 138 patients (166 feet) with HV deformities. Using a weightbearing plain radiograph in anteroposterior (AP) view, the intermetatarsal angles (IMAs) and the hallux valgus angles (HVAs) of the control and study groups were measured. Using a semi-weightbearing coronal computed tomography (CT) axial view, the α angle was measured in the control and study groups. In addition, the tibial sesamoid grades in plain radiograph tangential view and the CT axial view were measured. The tibial sesamoid position in an AP view was checked preoperatively. Based on these measurements, 4 types of HV deformities were defined.
Results: The mean values of the α angle in the control and HV deformity groups (control group µ = 13.8 degrees, study group µ = 21.9 degrees) was significantly different. Among 166 HV feet, 145 feet (87.3%) had an α angle of more than 15.8 degrees, which is the upper value of the 95% confidence interval of the control group, indicating the existence of abnormal first metatarsal pronation in HV deformity. Four types of HV deformities were defined based on their α angles and tibial sesamoid grades in CT axial view (CT 4 position). Among 25.9% (43/166) of the study group, abnormal first metatarsal pronation with an absence of sesamoid deviation from its articular facet was observed. The prominent characteristic of this group was that they had high grades in the AP 7 position (≥5); however, in the CT 4 position, their grade was 0. This group was defined as the “pseudo-sesamoid subluxation” group.
Conclusions: Patients with HV deformities had a more pronated first metatarsal than the control group, with a greater α angle. Pseudo-subluxation of the sesamoids existed in 25.9% of our study group. From our results, we suggest that the use of the CT axial view in assessments of HV deformity may benefit surgeons when they make operative choices to correct these deformities. With regard to the pseudo-sesamoid subluxation group, the use of the distal soft tissue procedure is not surgically recommended.
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Admin2 · Mar 27, 2015

Related Thread:
Does a tibial sesamoidectomy cause hallux valgus?

NewsBot · Sep 11, 2015

The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study
Jos? Mar?a Lamo-Espinosa, MDcorrespondenceemail, Borja Fl?rez, MD, Carlos Villas, MD, PhD, Juan Pons-Villanueva, MD, PhD, Jos? M. Bond?a, MD, Jes?s D?maso Aquerreta, MD, PhD, Matias Alfonso, MD, PhD
JFAS; Article in Press

Some investigators have emphasized restoring the relationship between the sesamoid complex and the first metatarsal head to reduce the risk of hallux valgus recurring after surgical reconstruction. In a prospective study, we analyzed whether the first metatarsophalangeal joint could be realigned after scarf-Akin bunionectomy without lateral soft tissue release. A total of 25 feet, in 22 patients, were prospectively enrolled and analyzed using anteroposterior radiographs and coronal computed tomography scans obtained before and 3 months after surgery. The Yildirim sesamoid position decreased from a preoperative of 2 (range 1 to 3) to a postoperative position of 0 (range 0 to 1; p < .001), the mean first intermetatarsal angle decreased from 12.6? ? 2.4? to 5.8? ? 2.1? (p < .001), and the mean distance between the second metatarsal and the tibial sesamoid changed from 25.7 ? 4.6 to 25.9 ? 4.6 (p = .59). Our findings suggest that dislocation of the sesamoid complex is actually caused by displacement of the first metatarsal. In conclusion, the scarf-Akin bunionectomy adequately restores the alignment of the first metatarsophalangeal joint, including restoration of the sesamoid apparatus, without direct plantar–lateral soft tissue release.
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NewsBot · Oct 13, 2015

Inter and Intra-Observer Reliability in Assessment of the Position of the Lateral Sesamoid in Determining the Severity of Hallux Valgus
Sunil Panchani, Jonathan Reading, Jaysheel Mehta
The Foot; Article in Press

Highlights
•The position of the lateral sesamoid correlates well in previous studies with the severity of Hallux Valgus.
•We performed an intra and inter observer reliability study on this classification system.
•Kappa Values were high amongst Consultant and Registrar observers.
•The Lateral Sesamoid Classification System shows good Intra and Inter Observer Reliability.
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Background
The position of the lateral sesamoid on standard dorso-plantar weight bearing radiographs, with respect to the lateral cortex of the first metatarsal, has been shown to correlate well with the degree of the hallux valgus angle. We aimed to assess the inter- and intra-observer error of this new classification system.

Methods
Five orthopaedic consultants and five trainee orthopaedic surgeons were recruited to assess and document the degree of displacement of the lateral sesamoid on 144 weight -bearing dorso-plantar radiographs on two separate occasions. The severity of Hallux Valgus was defined as normal (0%), mild (≤ 50%), moderate (51% - ≤99%) or severe (≥ 100%) depending on the percentage displacement of the lateral sesamoid body from the lateral cortical border of the first metatarsal.

Results
Consultant intra-observer variability showed good agreement between repeated assessment of the radiographs (mean Kappa = 0.75). Intra-observer variability for trainee orthopaedic surgeons also showed good agreement with a mean Kappa = 0.73. Intraclass correlations for consultants and trainee surgeons was also high.

Conclusion
The new classification system of assessing the severity of Hallux Valgus shows high inter- and intra-observer variability with good agreement and reproducibility between surgeons of consultant and trainee grades.
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NewsBot · Aug 12, 2016

Tibial Sesamoid Position Influence on Functional Outcome and Satisfaction After Hallux Valgus Surgery
Jerry Yongqiang Chen et al
Foot & Ankle International August 11, 2016

Background: During hallux valgus surgery, the abnormal position of the first metatarsal bone relative to the sesamoids is addressed. Our study aimed to investigate the influence of postoperative tibial sesamoid position (TSP) on functional outcome and patient satisfaction after hallux valgus surgery.
Methods: Between February 2007 and November 2011, 250 patients who underwent hallux valgus surgery at our tertiary hospital were followed for 2 years after surgery. They were categorized into 2 groups based on Hardy and Clapham’s TSP classification, recorded on postoperative weight-bearing anteroposterior (AP) radiographs: (1) normal (grades I-IV) and (2) outliers (grades V-VII).
Results: The mode TSP improved from grade VII preoperatively to grade IV postoperatively (P < .001). The visual analog scale for pain was 1 (95% CI 0, 1) point better in the normal group compared to the outlier group at 2 years after surgery (P = .050), whereas the American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale was 6 (95% CI 2, 11) points higher in the normal group (P = .009). Patients in the outlier group were also more likely to be dissatisfied with the surgery performed when compared to the normal group (OR 3.881, 95% CI 1.689, 8.920, P = .001).
Conclusion: We recommend correcting the TSP to grade of IV or less to improve functional outcome and satisfaction after hallux valgus surgery.
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NewsBot · Aug 17, 2016

Relationship Between Displacement and Degenerative Changes of the Sesamoids in Hallux Valgus
Ryuhei Katsui et al
Foot & Ankle International August 16, 2016

Background: Although the tangential sesamoid view is used to visualize the sesamoid position relative to the first metatarsal head, correctly evaluating patients with severe varus of the first metatarsal is difficult. Computed tomography (CT) can be helpful due to its cross-sectional images in any plane. The purposes of this study were to evaluate the alignment of the tibial sesamoid and investigate the relationship between malalignment and degenerative change in the sesamoid metatarsal joint (SMJ) using simulated weight-bearing CT imaging in patients with hallux valgus.
Methods: In total, 269 feet from 142 patients with hallux valgus were included. The mean age was 63.7 years (range, 33-87 years). An anteroposterior weight-bearing radiograph was assessed for sesamoid position into 3 grades: grade 1, the tibial sesamoid was medial to the axis of the first metatarsal; grade 2, the tibial sesamoid was located below the first metatarsal axis; and grade 3, the tibial sesamoid was lateral to the first metatarsal axis. The hallux valgus and intermetatarsal angles (HVA and IMA, respectively) were measured. The lateral shift of the tibial sesamoid relative to the first metatarsal was classified into 3 grades on simulated weight-bearing CT classification: grade 1, tibial sesamoid was entirely medial to the intersesamoid ridge; grade 2, tibial sesamoid was subluxated laterally but located below the intersesamoid ridge; and grade 3, tibial sesamoid was located entirely lateral to the intersesamoid ridge. The differences of HVA and IMA in each grade were confirmed by using 1-way analysis of variance with Bonferroni post hoc corrections. Furthermore, multiple linear regression analysis was used to predict the degenerative change in the SMJ for age, sex, sesamoid position determined by CT or plain radiography, HVA, and IMA. The χ2 test was used for descriptive statistics to analyze the agreement between radiography or CT classifications of sesamoid position against degenerative change in the SMJ.
Results: Based on the radiographic classification of the tibial sesamoid position, 7 feet were classified as grade 1, 72 were grade 2, and 190 were grade 3, respectively. Based on the CT classification, 34 feet were classified as grade 1, 116 were grade 2, and 119 were grade 3. Degenerative change in SMJ progressed according to the sesamoid shift relative to the first metatarsal using either radiography or CT. In radiography, statistically significant differences were found except for the difference in HVA between grades 1 and 2. In addition, statistically significant differences were found between HVA and IMA, along with the grades in CT.
In multiple linear regression, degenerative change was correlated with age and sesamoid position in CT and radiographic classifications.
Conclusion: Our study showed that lateral shift of the tibial sesamoid increased in association with progression of the hallux valgus deformity. Furthermore, increasing lateral shift of the tibial sesamoid was associated with worsening degenerative change within the SMJ.
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NewsBot · Feb 21, 2018

Importance of postoperative sesamoid reduction on the outcomes of proximal chevron osteotomy for moderate to severe hallux valgus deformity
Keun-Bae Lee, Myung-Sun Kim, Kyung-Soon Park, Gun-Woo Lee,
Foot and Ankle Surgery; 16 February 2018

Highlights
•Sesamoid reduction is important factor that influences recurrence of hallux valgus deformity.
•The radiographic outcomes and recurrence rate were significantly worse in the sesamoid non-reduction group despite a similar clinical outcomes and patient satisfaction between the two groups.
•Postoperative incomplete reduction of the sesamoid position can result in higher recurrence of hallux valgus and poor outcomes.
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Background
The purpose of this study was to compare the clinical and radiographic outcomes between feet with or without postoperative sesamoid reduction of proximal metatarsal chevron osteotomy for moderate to severe hallux valgus deformity.

Methods
All of 110 feet were allocated into two groups (reduction group; 66 feet, non-reduction group; 44 feet) according to the reduction status of sesamoid at 6 months after surgery. The clinical and radiographic results of the two groups were compared preoperatively, 6 months follow-up, and at last follow-up.

Results
The overall improvement in clinical outcomes was similar in both groups at average 4-year follow-up. However, the radiographic outcomes and recurrence rate were significantly worse in the sesamoid non-reduction group.

Conclusions
Our results suggested that postoperative incomplete reduction of sesamoid may increase a risk for the recurrence of hallux valgus
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NewsBot · May 23, 2019

Sesamoid malalignment in hallux valgus: Radiographic and MRI measurements and their correlation with internal derangement findings of the first metatarsophalangeal joint.
Skweres J et al
Br J Radiol. 2019 May 22:20190038

OBJECTIVE:
Sesamoid displacement (SD) and rotation are important components in the preoperative assessment of hallux valgus (HV). To date, Inter reader reliability (IRR) of SD on X-rays and MRI, correlations with hallux valgus angle (HVA), and qualitative changes of the hallux-sesamoid complex (HSC) on MRI have not been studied. The aim of this study was to correlate sesamoid malalignment with HV severity and findings of internal joint derangement.

METHODS:
Two readers analyzed a series of 56 consecutive patients who had X-rays and MRI performed on the same foot within 3 months of each other. Multiple measures of SD on X-rays and MRI and the sesamoid rotation angle (SRA) on MRI were assessed and correlated with HVA and various qualitative features at the HSC including cartilage, plantar plate, and collateral ligament abnormalities.

RESULTS:
We found excellent IRR (ICC = 0.79 - 0.99) for SRA on MR, but poor IRR for lateral sesamoid displacement (LDS) and tibial sesamoid position (TSP) scales on both modalities. Good IRR was also seen for morphologic abnormalities of HSC. The absolute value of the SRA on MR positively correlated with HVA ( p < 0.0001). LDS and TSP on both modalities lacked a significant correlation with HVA ( p > 0.05). No correlation was found between any measure of SD or rotation with HSC morphologic changes ( p > 0.05).

CONCLUSION:
Among different measures of sesamoid malalignment, sesamoid rotation angle measured on MRI can be used to judge the severity of HV; however, it does not correlate with qualitative morphologic abnormalities of the HSC.

ADVANCES IN KNOWLEDGE:
The MRI measurement of SRA is a better indicator of sesamoid displacement relative to the HSC than standard AP radiographic measures of non-rotational sesamoid displacement; however, it should not be used to predict qualitative morphologic abnormalities of the HSC
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NewsBot · Jun 7, 2019

Correlation of the Hallux Sesamoids’
Orientation with Various Anatomical
Parameters in Patients with Hallux Valgus
Deformity
Kalliopi Iliou , George K. Paraskevas , Panagiotis Kanavaros , Alexandra Barbouti ,
Aikaterini Kitsouli , Christos Gekas , Panagiotis Kitsoulis
Cureus 11(5): e4643. DOI 10.7759/cureus.4643

Introduction
An awareness of the anatomical parameters of the foot such as the position and orientation of
the sesamoid bones can be of great value for the etiology and diagnostic approach to patients
with hallux valgus (HV). The purpose of this study was to evaluate the basic anatomical features
and measurements related to the characteristics of HV in cadaveric material.
Materials and methods
The study sample included 12 cadaveric limbs with HV and 10 cadaveric limbs without HV as a
control group. We measured the HV angle (HVA), the first to second intermetatarsal angle
(IMA), and the first to fifth IMAs of all samples. We also recorded the shape of the first
metatarsal head and the position/orientation of the sesamoid bones.
Results
The mean values of the HVA (p = 0.000), the first to second IMA (p = 0.000), and the first to fifth
IMA (p = 0.000) differed between the HV and non-HV group. The position of the sesamoid
ossicles between the HV and the non-HV group was statistically significant (p = 0.001). While
we noted the round shape of the first metatarsal head was predominant in HV samples, we
found no statistically significant difference in the first metatarsal head shape between the test
and control groups.
Conclusion
The HVA, the first to second IMA, the first to fifth IMA, and the orientation of the sesamoid
ossicles differed significantly between cadaveric samples with HV and those without HV.
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NewsBot · Jul 19, 2019

Correlation of the Hallux Sesamoids' Orientation with Various Anatomical Parameters in Patients with Hallux Valgus Deformity.
Iliou K et al
Cureus. 2019 May 11;11(5):e4643

Introduction An awareness of the anatomical parameters of the foot such as the position and orientation of the sesamoid bones can be of great value for the etiology and diagnostic approach to patients with hallux valgus (HV). The purpose of this study was to evaluate the basic anatomical features and measurements related to the characteristics of HV in cadaveric material. Materials and methods The study sample included 12 cadaveric limbs with HV and 10 cadaveric limbs without HV as a control group. We measured the HV angle (HVA), the first to second intermetatarsal angle (IMA), and the first to fifth IMAs of all samples. We also recorded the shape of the first metatarsal head and the position/orientation of the sesamoid bones. Results The mean values of the HVA (p = 0.000), the first to second IMA (p = 0.000), and the first to fifth IMA (p = 0.000) differed between the HV and non-HV group. The position of the sesamoid ossicles between the HV and the non-HV group was statistically significant (p = 0.001). While we noted the round shape of the first metatarsal head was predominant in HV samples, we found no statistically significant difference in the first metatarsal head shape between the test and control groups. Conclusion The HVA, the first to second IMA, the first to fifth IMA, and the orientation of the sesamoid ossicles differed significantly between cadaveric samples with HV and those without HV.
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NewsBot · Aug 2, 2019

Lateral Sesamoid Position Relative to the Second Metatarsal in Feet with and without Hallux Valgus.
Machado DG et al
Rev Bras Ortop (Sao Paulo). 2019 Apr;54(2):165-170

Objective To determine if the sesamoids migrate laterally in the feet with hallux valgus or if they only appear to move, maintaining their relationship with the other forefoot structures. Methods Anteroposterior radiographs of 80 patients (94 feet, all weight-bearing), from the period between 2015 and 2016, were evaluated. Forty-eight had a valgus hallux angle greater than 15° (hallux valgus group) and 46 presented a hallux valgus angle lower than 15° (control group). The distances from the first metatarsus head and the lateral sesamoid bone to the second metatarsus axis were measured. Subsequently, the coefficients of these distances were determined by the length of the second metatarsus to adjust it for different foot sizes. Results Both the absolute and the relative measures from the first metatarsus head to the second metatarsus axis were significantly different between the groups, with a positive correlation with hallux valgus and intermetatarsal angles. However, neither the absolute nor the relative distance of the lateral sesamoid bone to the second metatarsus was different between the groups, as they did not correlate with hallux valgus or intermetatarsal angles. Conclusion Despite the medial deviation of the first metatarsus in hallux valgus, the sesamoid bone maintains its relationship with the second metatarsus in the transverse plane. This apparent lateral displacement may lead to misinterpretation of these radiographs. This fact is of paramount importance in the pre-, intra-, and postoperative period of patients with hallux valgus.
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NewsBot · Sep 26, 2019

Relationships Between First Metatarsal and Sesamoid Positions and Other Clinically Relevant Parameters for Hallux Valgus Surgery
Naohiro Shibuya et al
JFAS; Article in Press

Relationships between hallux valgus (HV) and other measurements within the first ray have been extensively studied. It is becoming more popular to correct HV deformity with tarsometatarsal joint arthrodesis while internally (varus) rotating the first metatarsal. This, in turn, reduces the sesamoid position when viewed in the dorsoplantar projection on radiographs. However, it has been shown that not all HV deformities have pathological external (valgus) rotation of the first metatarsal. In this study, we explored the relationships between frontal-plane rotations of the first metatarsal as well as the sesamoids, and other factors not limited to the first ray, to better understand the pathological process of HV deformity and to assist in surgical planning. We found that when adjusting for these covariates, the only factor associated with first metatarsal external rotation was having less metatarsus adductus. Sesamoid rotation, on the other hand, was independently associated with the HV angle, tibial sesamoid position, and medial column collapse. When surgically treating HV, correction of sesamoid rotation may need to be prioritized.
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NewsBot · Dec 25, 2019

The change of the sesamoid rotation angle in patient with hallux valgus at walking position.
International Journal of Sports Physical Therapy . Dec2019, Vol. 14 Issue 6, pS8-S9. 2p.
Arisu, H.; Urabe, Y.; Sasadai, J.; Sakai, S.; Shimizu, R.; Kobayashi, T.; Maeda, N.

Objective: Hallux valgus (HV) occurs frequently in athletes. HV includes changes in the alignment of rotating sesamoid bones and shifting abductor hallucis muscle (ABH) to the plantar direction. It is unknown if sesamoid rotation is promoted during walking and if the chronic tension stress of ABH from rotated sesamoid cause atrophy of ABH. No study investigated the difference of sesamoid rotation angle (SRA) between non-weight bearing position and walking position. Therefore, this study aimed to investigate the change of SRA at walking position and atrophy of ABH. Methods: Participants were divided into HV angles of > 20° (HV group; 12 women, HV angle 27.4° ± 5.5°) and < 20° (control group; 13 women, HV angle 14.8° ± 2.0°). The SRA and CSA were measured using ultrasonography. The SRA was measured at the following positions; non weight bearing, standing, mid-stance, and pre-swing phase. Cross-sectional area (CSA) of the ABH was measured in the supine position. Independent t-test or Mann-Whitney's U test was conducted to compare the differences in the mean values of SRA compared with non weight bearing and CSA between the two groups using the 5% level of significance. Results: In HV group, the SRA compared with non weight bearing increased 3.6°±0.1° at standing (p=0.09), 4.4°±1.2°at mid-stance (p=0.06), and 4.2°±0.4° at pre-swing (p < 0.05) more than control group. The CSAs were 200.2±47.7 and 204.7±49.8 mm2 in the HV and control group (p=0.78). Conclusion: Our results suggest that weight bearing while walking would lead to increase SRA. However, CSA between the two groups was not different in this study. There was no atrophy of ABH. It is thought that the progression of HV angle is promoted by the reduction of the abduction torque of the ABH by the large outward displacement of the sesamoid at weight bearing on the forefoot. Clinical implications: We concluded the SRA in the HV group increased more during weight bearing on the forefoot.
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NewsBot · Mar 18, 2020

High Prevalence of Degenerative Changes at the Metatarsal Head Sesamoid Articulation Found During Hallux Valgus Correction Surgery.
Tsai J et al
Foot Ankle Spec. 2020 Mar 16

Background. Despite the absence of complications and a restoration of normal hallux alignment, some patients have suboptimal outcomes from hallux valgus correction surgery. One risk factor for persistent pain may be the presence of arthritic changes at the metatarsal head articulation with the sesamoids, an area not easily assessed with standard radiographs unless dedicated sesamoid views are obtained. In this study, we prospectively evaluated the metatarsal head for degenerative changes during hallux valgus correction surgery and identified preoperative risk factors associated with these changes. Methods. We prospectively evaluated 200 feet in 196 patients who underwent hallux valgus surgery intraoperatively for the pattern and severity of arthritic changes at the metatarsal head. Mann-Whitney U testing was implemented to compare differences in arthritic scores between preoperative deformity groups. The Spearman correlation test was used to determine the association between age and preoperative deformity with the severity of degenerative changes. Results. More than half of all feet assessed had severe arthritic changes at the plantar medial aspect of the metatarsal head and 40% of feet at the plantar lateral aspect. Age and intermetatarsal angle were found to be positively correlated with arthritis in this area. Conclusion. Our prospective study has demonstrated the high prevalence of arthritic changes at the metatarsal head sesamoid articulation and the positive influence of age and severity of deformity on metatarsal head arthritic changes seen during hallux valgus correction surgery. Furthermore, these arthritic changes were found to have no significant influence on preoperative functional and pain levels.
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NewsBot · Mar 18, 2020

Effect of sesamoid position on functional outcome of operated hallux valgus.
Zitouna K, Selmene MA, Khlif MA, Riahi H, Barsaoui M.
Tunis Med. 2019 Dec;97(12):1370-1374.

INTRODUCTION:
The loss of correct relationships between the sesamoid and the first metatarsal is one of the architectural consequences of the hallux valgus (HV). The reduction of this dislocation by lateral soft tissue release (LSTR) is one of the objectives of surgery.

AIM:
To study the relationship between postoperative position of sesamoid and clinical outcome at one-year postoperative follow-up.

METHODS:
It's a retrospective study including patients operated for evolved HV performed in la Rabta orthopedic department in Tunis. These patients had a Scarf osteotomy associated with at least one Weil osteotomy. The functional evaluation was based on the AOFAS score (American-orthopedic-foot-and-ankle-society). We classified the sesamoid position according to 3 scores: Hardy & Clapham , RCAOFAS and the Agrawal. We compared each score of the sesamoid position to the clinical outcome.

RESULTS:
We collected 46 cases of HV in 45 patients. The mean AOFAS score increased from 60,9 to 85,5/100 postoperatively. Our patients were divided into 2 groups: group A whose result was excellent and group B whose result was good, fair and poor. The analytical study of this work concluded that there was no relationship between the postoperative sesamoid position and the clinical outcome, regardless of the radiological classification used (p=0,361, p=0,222, p=0,260).

CONCLUSION:
Sesamoids that remain in postoperative dislocation are not necessarily predictive of a poor clinical outcome at one year of the surgical cure.
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NewsBot · Jul 2, 2020

Classification of Hallucal Sesamoid Bone Correlated with Hallux Valgus Severity
Lei Zhang et al
Volume 2020 |Article ID 9658916 | 10 pages | https://doi.org/10.1155/2020/9658916 27 Jun 2020

The hallucal sesamoid bones (HSBs), having an important role in reducing load per unit area on the first metatarsal head, can be injured commonly which also affected the first metatarsophalangeal joint and the surrounding structure. Meanwhile, differences among each HSB type may be a major factor affecting the occurrence and development of HV. So far, many researchers had learned that there are three different conditions in hallucal sesamoid bone affecting the choice of clinical surgery corresponding to different solutions in clinic. Thus, it is necessary to study the anatomical morphological characteristics of the HSB which can be helpful in clinical diagnosis and treatment, especially hallux valgus (HV). 150 X-ray and three-dimensional (3D) computed tomographic (CT) images consist of 72 left and 78 right metatarsals were applied in this anatomic study between two variables and showed by a simple scatter plot. The first metatarsophalangeal joint is divided into four different types: type I (no HSB, 1.3%), type II (with one HSB, 0.07%), type IIIa (with two HSBs when THB is bigger, 28%), type IIIb (with two HSBs when FHB is bigger, 65.3%), and type IV (with three HSBs, 4.7%). There was no statistical difference between the left and right sides, except HVA, Meary, and pitch (); all a, b, c, d, and i have statistical difference between male and female (). Meanwhile, HVA and IMA and HVA and type group have a significant correlation. In summary, HVA and IMA and HVA and classification of HSBs have significant correlations. The classification and location of HSBs can be an important basis to choose operation methods and postoperation evaluation.
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NewsBot · Dec 24, 2021

INFLUENCE OF SESAMOID POSITION AFTER SCARF OSTEOTOMY FOR HALLUX VALGUS ON PATIENT-REPORTED OUTCOME. A PROSPECTIVE COHOR STUDY
EvaVeracruz-Galvez et al
Foot and Ankle Surgery 23 December 2021

Background
The objective was to evaluate the influence of the postoperative sesamoid position as measured with conventional radiographs on the patient-reported outcome after scarf osteotomy. The hypothesis was that incomplete reduction of the sesamoid would result in a decreased functional outcome.

Methods
Eighty-two patients who underwent scarf osteotomy for hallux valgus were prospectively assessed for up to two postoperative years. The Self-Reported Foot and Ankle Score (SEFAS) was used to assess the quality of life, and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS) for the functional outcome. A visual analogue scale (VAS) assessed pain, and Likert scale for patient satisfaction. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and sesamoid position were analyzed. According to the final sesamoid position, patients were classified as normal position (48 patients) and outlier position (34 patients). A power analysis, conventional and logistic regression statistical analysis were performed.

Results
At the final follow-up, significant improvements in all clinical scores were observed for both groups (p= 0.001) with no significant difference in AOFAS score (p= 0.413), but SEFAS score (p= 0.023), VAS-pain (p= 0.006), and satisfaction (p= 0.014) were significantly better in the normal group than in the outlier group. There were significant differences between groups in final HVA (p= 0.042) and IMA (p= 0.040). In multivariate analysis, only lower VAS-pain score (OR 0.4, 95% CI 0.2-0.6; p= 0.039) and normal sesamoid position (OR 2.4, 95% CI 1.6-3.2; p= 0.012) were significant predictor of patient satisfaction.

Conclusion
At two postoperative years, normal sesamoid position as measured on weight-bearing radiographs was associated with lower pain and better patient satisfaction in patients underwent scarf osteotomy for moderate to severe hallux valgus.
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NewsBot · Feb 15, 2022

Does the sesamoid rotation angle change differently in subjects with hallux valgus considering foot position during assumed walking?: A pilot study
ArisuHirotaNoriakiMaedaShogoSakaiMasanoriMorikawaTakumiKobayashiReiaShimizuSomuKotoshibaJunpeiSasadaiTsubasaTashiroYukioUrabe
The Foot; 11 February 2022, 101911

Highlights
•The sesamoid rotation angle (SRA) of all positions and the change in the SRA at the pre-swing increased in the Hallux valgus (HV) group than in the non-HV group.
•No statistically significant difference between the two groups with respect to cross-sectional area of the abductor hallucis muscle (ABH) in this study.
•In the HV group, larger change in the SRA during load on forefoot is associated with smaller size of ABH.
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Hallux valgus (HV) entails changes in the alignment of the rotating sesamoids and a shift of the abductor hallucis muscle (ABH) in the plantar direction, decreasing the abductor force. Load on the foot while walking may change the sesamoid rotation angle (SRA). Nevertheless, no study has investigated the relationship between the change in SRA during assumed walking and ABH muscle size. The aim of our study was to examine the changes in SRA at different foot postures assumed to generate skeletal alignments during walking and muscle size of the ABH in participants with HV and to discuss the association between the change in the SRA and cross-sectional area (CSA) of the ABH.

Thirteen female participants were recruited and divided into the HV and non-HV groups according to the HV angle. The SRA and cross-sectional area of the ABH were measured using B-mode ultrasound. The SRA was measured under four conditions; sitting, standing, mid-stance, and pre-swing posture. The CSA was assessed in the supine position.

In all postures, the SRA increased more in the HV group than in the non-HV group (p < 0.05). The change in the SRA at the pre-swing posture was greater in the HV group than in the non-HV group (p < 0.05). The change in the SRA at pre-swing posture negatively correlated with the CSA of the ABH in the HV group (r = −0.554, p < 0.05).

In the HV group, increasing the load on the forefoot enhanced the sesamoid rotation. Abductor torque on the ABH decreased with ABH displacement as the sesamoids moved laterally in the pre-swing. Repeated walking increased sesamoid rotation and led to HV progression. Therefore, it may be beneficial to use an orthosis or arch pad that corrects pronation of the metatarsal with the rotation of the sesamoids.
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NewsBot · Apr 17, 2022

Mechanical Axis Method to Determine First Intermetatarsal Angle and Tibial Sesamoid Position
Noman A. Siddiqui, DPM, MHA, FACFAS et al
April 04, 2022

Utilizing the mechanical axis can decrease load on the joint and be beneficial when analyzing bony deformities and planning surgical correction with osteotomies. The aim of this study was to identify the normal mechanical axes of the first and second metatarsals and use them to obtain the first/second mechanical intermetatarsal angle (mIMA). The mechanical axis of the first metatarsal was used to obtain the mechanical tibial sesamoid position (mTSP), which provides a mechanical relationship with the sesamoid apparatus. The angular difference between the anatomic and mechanical axis lines (anatomic-mechanical angle [AMA]) was determined for the first metatarsal and for the second metatarsal. The commonly used first/second anatomic intermetatarsal angle (aIMA) and anatomic tibial sesamoid position (aTSP) were also obtained and compared with the first/second mIMA and mTSP. In this retrospective analysis, radiographs of 50 normal feet (40 patients) were assessed. Pearson's correlation coefficients were used to measure reliability between obtained measurements. Mean first/second aIMA was 8.6 ± 3.0 degrees, and first/second mIMA was 8.6 ± 2.6 degrees. First metatarsal AMA was 1.1 ± 1.0 degrees; second metatarsal AMA was 2.0 ± 1.6 degrees. The mTSP was 2.8 ± 1.1, and aTSP was 2.9 ± 1.0. The TSP median was 3 (range, 1-5). Using the mechanical axis method to obtain the first/second mIMA and the mTSP is reproducible and not affected by anatomic changes to the shape of the metatarsal. Unlike the anatomical axis, the mechanical axis does not change, therefore we recommend using the mechanical axis during surgical planning and when obtaining preoperative and postoperative measurements for the long bones of the foot, particularly for forefoot conditions such as hallux valgus.
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NewsBot · Feb 28, 2023

Medial sesamoid position in moderate to severe hallux valgus: Correlation between three radiographic measurements
Seok-Min Hwang et al
J Orthop Sci. 2023 Feb 24

Background: In hallux valgus surgery, it is essential to accurately assess the position of the sesamoids both pre- and postoperatively. Weight-bearing foot anteroposterior, tangential sesamoid, and semi-weight-bearing computed tomography axial views are radiographic methods used to assess the medial sesamoid position. This study aimed to measure the medial sesamoid position and evaluate the correlation between these three radiographic methods.

Methods: This retrospective study comprised 59 feet from 49 patients who underwent hallux valgus surgery. The mean age of patients was 54.6 (range, 22-70) years. We took preoperative and postoperative measurements using the weight-bearing anteroposterior, tangential sesamoid, and semi-weight-bearing computed tomography axial views to assess the medial sesamoid position.

Results: The mean grades of the medial sesamoid position preoperatively and 6 months postoperatively were 2.5 and 0.8, 1.6 and 0.4, and 1.3 and 0.3 points based on the anteroposterior, tangential sesamoid, and computed tomography axial views, respectively (P < 0.001). Preoperatively, there was a strong positive correlation between the computed tomography axial and tangential sesamoid views (P < 0.001, r = 0.645) and anteroposterior and computed tomography axial views (P < 0.001, r = 0.468). In contrast, the tangential sesamoid and anteroposterior views showed a weak positive correlation (P = 0.03, r = 0.283). Six months postoperatively, there was a positive correlation between the computed tomography axial and tangential sesamoid views (P < 0.001, r = 0.473), anteroposterior and computed tomography axial views (P < 0.001, r = 0.470), and tangential sesamoid and anteroposterior views (P < 0.001, r = 0.480).

Conclusions: We observed that the anteroposterior view exhibited a higher degree of medial sesamoid position displacement than the computed tomography axial and tangential sesamoid views. For the preoperative evaluation of the medial sesamoid position, the correlation between the computed tomography axial and tangential sesamoid views was stronger than that between the tangential sesamoid and anteroposterior views. However, all three views showed strong correlations postoperatively.
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NewsBot · Jul 28, 2023

Relationship between medial partite hallux sesamoid and hallux valgus in the general population
Junya Higuchi et al
Foot and Ankle Surgery 25 July 2023

Background
An association between the medial partite hallux sesamoid (MPHS) and hallux valgus (HV) has been suggested; however, a causal relationship has not been confirmed. This study aimed to determine their causal relationship using a cross-sectional radiographic survey of a large-scale population cohort covering a wide age group.

Patients and Methods
The fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1997 participants aged 21–95 years who had undergone anteroposterior radiography of bilateral feet. The presence of MPHS, its morphology, and radiographic parameters related to the HV were assessed using radiographs. Changes in the prevalence of MPHS with age were assessed using trend tests. The relationship between the MPHS and HV was assessed based on sex and age.

Results
MPHS was found in 508 out of 3994 feet (12.7%), with a significant difference in prevalence between men and women (10.0% vs. 13.7%, p<0.001). Trend analysis demonstrated a significant decrease in MPHS occurrence with age in both sexes. HV angle was significantly higher in feet with MPHS than in those without (Men: 17.8 ± 7.0° vs. 14.0 ± 5.9°, p < 0.0001; Women: 19.6 ± 7.7° vs. 17.7 ± 7.9°, p < 0.0001). The prevalence of HV angle ≥ 20° was also significantly higher in feet with MPHS than in those without (Men: 33.3% vs. 14.6%, p < 0.0001; Women: 46.5% vs. 34.6%, p < 0.0001). This association between MPHS and HV was noticeable in younger adults and became less prominent with age.

Conclusions
MPHS is associated with HV. The weakening of this relationship and the decreased prevalence of MPHS with age suggest that MPHS is not caused by HV, but is one of the causes of HV, especially in younger adults.
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NewsBot · Aug 16, 2023

Evaluation of the alignment of the intersesamoidal ridge’s axis through 3D-printing models and digital method
Türkten İ., Ayanoğlu S., Şakul B. U.
20th Congress of the International Federation of Associations of Anatomists, İstanbul, Turkey, 5 - 07 August 2022, vol.16, pp.140

Objective: To evaluate the angle between the axis of the intersesamoidal ridge of the first metatarsal and the axis of the first metatarsal, studies were previously performed on dry bones. However, since dry bones can not accurately reflect the first metatarsophalangeal angle, it is not easy to establish its relationship with Hallux Valgus (HV). A 3D-Printed model may be important in accurately detecting the ridge axis in individuals with HV and health. Methods: According to our power analysis, 51 retrospectives computed tomographies of 25 individuals with HV and 26 healthy individuals were collected. The first metatarsal was modeled via 3D slicer software and exported in STL format. The angle between the axis of the intersesamoidal ridge and the axis of the first metatarsal was measured digitally via Ansys software. At the same time, the 3D-Print of the relevant model was taken and it was measured manually with a transparent protractor. Results: In the study, since the variables were normally distributed, dependent groups were measured with the t-test. As a result of the analysis, it was observed that there was no significant difference between digital and manual measurements (p>0.05). One case from the HV group was unsuitable for ridge measurement. Conclusion: In this study, we provide a protocol for detecting the ridge axis with an accurate, easy, and inexpensive method. 3D Models can be useful in the preoperative planning phase in HV surgery.
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NewsBot · Feb 21, 2024

Are sesamoids and proximal phalanx of metatarsus primus varus deformity of hallux valgus feet displaced? A radiological study
Daniel Yiang Wu, Eddy Kwok Fai Lam
J Orthop Surg (Hong Kong). 2024 Jan-Apr;32(1):10225536241233474

Background: The hallux valgus deformity is made up of misaligned first metatarsal, hallux, and sesamoids. Their angular deformities are well-studied, but not their positional displacements. A few available reports claimed the proximal end of the proximal phalanx and sesamoids were not shifted medially along with the first metatarsal head. However, the general observation is otherwise. This study revisits the issue.

Methods: A radiological study of 189 feet with and without the hallux valgus deformity was carried out to analyze the first metatarsal, hallux, and sesamoid positional changes in relation to the second metatarsal and among themselves. A total of 194 X-ray images with all relevant measurements that formed the raw database for this study were submitted for online viewing and reference.

Results: There was a statistically significant change in the first metatarsal, hallux, and sesamoid positions of feet with hallux valgus deformity compared to normal feet. All have migrated medially but to different degrees. It was contrary to the past findings of no change in sesamoid and hallux positions.

Conclusions: We agree with past findings that the metatarsus primus varus deformity is directly related to the failed medial metatarsosesamoid ligament. We also believe in the failure of the deep 1-2 transverse metatarsal ligament responsible for the sesamoid migration.
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NewsBot · Feb 22, 2024

Impact of Sesamoid Coverage on Clinical Foot Function Following Fourth-Generation Percutaneous Hallux Valgus Surgery
Thomas Lorchan Lewis et al
Source

Background:
The impact of pronation and sesamoid coverage on clinical outcomes following percutaneous hallux valgus surgery are not currently known. The aim of this study was to investigate if sesamoid coverage was associated with worse clinical outcomes at 12-month follow-up following percutaneous hallux valgus surgery.
Methods:
Retrospective comparative observational study of clinical and radiographic outcomes based on a previously published prospective dataset. Patients were stratified into 3 cohorts based on the degree of sesamoid coverage (normal, mild, or moderate) on 12-month weightbearing radiographs following fourth-generation percutaneous hallux valgus surgery. Primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included Euroqol-5D, VAS Pain, and radiographic deformity correction.
Results:
Forty-seven feet underwent primary fourth-generation HV surgery and were stratified into 3 cohorts. There were 19, 16, and 12 feet in the normal, mild, and moderate cohorts respectively. There was no significant difference in either pre- or postoperative foot function (all MOXFQ domains, P > .05) or health-related quality of life (EQ-5D Index or VAS, P > .05). The MOXFQ Index preoperatively was as follows: normal cohort, 56.1 ± 26.9; mild cohort, 54.1 ± 17.9; and severe cohort, 49.6 ± 23.8; and postoperatively was as follows: normal cohort, 15.6 ± 21.5; mild cohort, 11.4 ± 15.5; and severe cohort, 11.4 ± 13.6 (P = .737-.908). There was significantly worse hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the cohorts (P < .01). Although HVA and IMA were corrected to normal parameters following surgery in all cohorts, there was a significantly worse postoperative HVA in the moderate sesamoid coverage (5.3 ± 3.9 vs 7.9 ± 5.3 vs 11.4 ± 3.7, P < .01); however, IMA was not significantly different (3.4 ± 2.2 vs 4.1 ± 2.7 vs 5.2 ± 2.9, P = .168).
Conclusion:
This study found that cases where the sesamoids were not reduced had a poorer correction and had worse preoperative deformity. Clinical outcomes and foot function following fourth-generation percutaneous hallux valgus surgery were not affected by sesamoid coverage at the 12-month follow-up. The long-term implications in the difference in radiographic deformity between the 3 cohorts are not known, and further work should explore the relationship of first ray pronation and sesamoid position, particularly with regard to recurrence.
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Localised swelling remains below ball of foot despite sesamoidectomy

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Dancer's Pad/ Sesamoid Pad

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