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50 year old bicyclist with a Hx of chronic pain at the plantar aspect right foot. No acute trauma. Failed to respond to conservative treatment including custom insoles, cortisone injections, physical therapy, decreased activity and oral NSAIs.

Dx: Fractured fibular sesamoid.

At time of surgery a mass (suspected fibrolipoma) was excised along with an Avascular necrotic fibular sesamoid (see photos)

Thought you might find this interesting.

 

Interesting case.

Both ossicles of the tibial sesmoid are pretty smooth, maybe it was a bipartate sesmoid and the blood flow became interrupted to the smaller ossicle from constant pressure from a repetitive stress injury, ie, constant peddling. Rare indeed, if it was a fractured sesmoid without a history of trauma.

Steven

 

Thanks for sharing. That's very interesting.

What pre op imaging was done (other than xray)? Bone scan/ MRI? Did it show up as pathological on imaging?

 

The xray does look like a tibial sesamoid....I may have taken a picture of the wrong xray. It was the lateral I operated on. Sorry for the confusion. I'll try and upload a DP view.

No, pre op was just xrays. It looked fractured, nothing else. No need really to order any other imaging. I was just surprised when I excised it that it was an AVN....with a mass over it.

After 3 decades I don't get surprised very often!

Steve