sesmoid/ turf toe/hallux varus Flashcards
1
Q
What are the two sesmoids called?
A
- Medial- tibial
- larger, greater weight bearing status, more commonly injured
- Lateral - fibular
- Bipartite sesmoids present in 10-25%
- 97% tibial sesmoid
- 25% bilateral
2
Q
What are they envelopes between?
A
- Flexor hallicis brevis
3
Q
What are they separated by?
A
- A Crista- inter sesmoid ridge
4
Q
How are they attached to the proximal phalanx?
A
- By the plantar plate
5
Q
What are they suspended by ?
A
- Collateral lig of mtp joint,
- metatarasesmoid junction
- intersesmoid lig,
- adductor hallicis longus ,
- adductor hallicis tendon
6
Q
What are their functions?
A
- Absorb weight bearing pressure
- Reduce Friction at MT head
-
Protect FHL tendon
- glides between sesmoids
- Provides Fulcrum for flexor hallucis brevis that increases MTP Flexion power
- To increase mechanical advantage of pulley function of intrinsics - fhb
7
Q
Which sesmoid fractures?
A
- The tibial- also greater chance of bipartitite
8
Q
What is the mechanism of sesmoid fracture?
A
- Forced dorsiflexion of first MTP
- most common
- potential avulsion of plantar plate off base of phalanx
- proximal migration of sesmoids
9
Q
What are the signs & symptoms of a pt with sesmoid injury?
A
Symptoms
- Generalized big toe pain
- worse in terminal part of stance phase
Sign
- Possible plantar-flexed MTP with cavus foot
10
Q
Name associated conditions of sesmoid injury?
A
- Bilateral sesmoiditis shoud raise concerns for
-
Reiter’s disease
- urethritis, conjuctivitis, iritis, inflammatory bowel disease
- Psoriatic disease
- Seronegative RA
11
Q
What investigations are helpful for dx semsoid injury?
A
Xrays
- AP and lateral foot standing
- medial oblique (sesmoid view)
- Axial sesmoid view
- proximal migration of sesmoids- suspicious of inrinsic minus hallux
Bone scan
- Helps distinguish bipartite sesmoid from a fracture
- increase uptake cf contralateral side helps dx
12
Q
What is the mx of sesmoid fractures?
A
Non operative
- NSAIDs, Reduced WEightbearing,Activity modification, orthoses
- BK leg cast with toe extension
- Fracture boot- limit stress across sesmoid Transition to sesmoid pad with gradual return to activity
Surgery
-
Partial or complete sesmoidectomy
- symptomatic post 3-12 months
- Autologous Bone graft
- Non union/fracture
- Dorsiflexion Osteotomy
- Plantar-flexed 1st ray with sesmoid injury
13
Q
What portion of the sesmoid is ok to remove ?
A
- Distal or proximal pole - best results
14
Q
Decribe the approach for excision of tibial sessmoid?
A
- Medial -plantar approach
- HIgh risk of injury to Proper branch if medial plantar nerve
15
Q
Describe the approach for excision of fibular sesmoid
A
- Plantar approach
- Beware if proper branch to lateral side of hallux
- first branch to first web space