First Metatarsophalangeal Joint Sesamoidopathy

Abstract

Hallucal sesamoids play a critical role in foot function as they protect the flexor hallucis longus tendon, increase the mechanical advantage of the flexor hallucis brevis tendon, facilitate load transmission to the medial forefoot, and minimize joint forces acting on the first metatarsophalangeal joint (MTPJ).¹-⁴ Disorders of these bones are not uncommon problems that pose a significant challenge to the foot surgeon as there are few good studies available that have studied the effectiveness of conservative and surgical treatments recommended to treat these disorders. These injuries can be disabling particularly for athletic patients and surgical extirpation may be contemplated. Concerning evidence-based medicine for surgical treatment, there are no level 1 or 2 prospective randomized studies to rely on with majority of studies being level 3, 4, or 5. Thus, recommended treatments are either anecdotal or based on limited case studies and few anatomical “bench studies.” Because of this lack of knowledge, there have also been many myths that abound pertaining to sesamoid pathology and the treatments rendered thus adding to the confusion. The purpose of this section is to generally review hallucal sesamoidopathy with emphasis on the role of surgery specifically discussing incisional approaches and recommended procedures for specific pathological conditions.