Sesamoid Position in Healthy Volunteers Without Deformity: A Computed Tomography Study.

We used coronal computed tomography to determine the normal sesamoid position in 20 healthy volunteers. The sample involved 40 feet (20 left [50%] and 20 right [50%]) in 20 volunteers, including 11 females (55%) and 9 males (45%). The relationship between the first metatarsal head and the sesamoid complex was categorized as Yildirim grade 0 in every case (100%). The mean width of the foot was 77.7 ± 5.8 mm, and the ratio of the foot width to the distance from the second metatarsal head to the tibial sesamoid was 39.6% ± 2.02%. Based on our findings, we consider Yildirim grade 0 to be the normal sesamoid alignment.

The Relationship Between the Sesamoid Complex and the First Metatarsal After Hallux Valgus Surgery Without Lateral Soft-Tissue Release: A Prospective Study.

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.

Neurectomy versus neurolysis for Morton's neuroma.

BACKGROUND: We evaluated a series of patients who underwent neurectomy or neurolysis for the surgical treatment of Morton's neuroma. MATERIALS AND METHODS: A group of 50 patients (69 feet) who underwent surgery for a symptomatic Morton's neuroma were retrospectively reviewed. Surgery was performed through a dorsal approach in all cases. When the nerve showed macroscopic thickening or the typical pseudoneuroma, it was resected; when the nerve had no macroscopic changes, the intermetatarsal ligament and any other potentially compressive structure were released. In 17 cases, adjacent claw toes were treated. RESULTS: Nerve thickening (pseudoneuroma) were resected in 46 cases; in the other 23 cases, the nerve was preserved. Total relief from digital nerve related symptoms was obtained in all cases but one in each group. These patients were reoperated on 6 months later by performing a neurectomy in the case where the nerve had been preserved, and a more proximal resection in the case in which the nerve had been resected. Both patients finally achieved complete pain relief. CONCLUSION: When treating Morton's neuromas surgically, neurolysis can be a valid option when a pseudoneuroma has not developed.

Solitary osteochondroma long-term follow-up.

A series of 113 osteochondromas were treated in our institution with a long-term follow-up. A retrospective study of the cases of solitary osteochondroma diagnosed and treated in our center from 1970 to 2002 was done. A diagnosis for clinical findings in 73% of the patients was made. The most frequent location was the distal femur. Six patients had a recurrence and in two patients the lesions became malignant and chondrosarcoma developed. Relapse of the exostosis is rare, occurring in an estimated 2% of the resections. The growth of an osteochondroma and/or the presence of pain in older patients suggest possible malignancy.