Beware the hallucal interphalangeal joint sesamoid in first metatarsophalangeal joint arthrodesis. Issue 3 (June 2018)

• Record Type: Journal Article
• Authors: Wong-Chung, John; Arneill, Matthew; Lloyd, Richard
• Is Part Of: Foot and ankle surgery. Volume 24:Issue 3(2018)
• Page Start: e18
• Page End: e22
• Publication Date: 2018-06
• Subjects: Hallux -- Interphalangeal joint -- Hallucal interphalangeal joint sesamoid -- Plantar keratoma -- First metatarsophalangeal joint arthrodesis; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2018.04.001
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: Beware the hallucal interphalangeal sesamoid in arthrodesis of first MTP joint. Plantar keratoma beneath hyperextended interphalangeal joint of great toe. Good outcome following excision of hallucal interphalangeal sesamoid. Moberg osteotomy only pushes big toe nail higher against toe box. Consider excision of interphalangeal sesamoid at time of MTP1 arthrodesis. Abstract: Background: We describe a previously unreported presentation of the hallucal interphalangeal joint sesamoid (HIPJS) following arthrodesis of the first metatarsophalangeal joint (MTP1). Methods: Of 438 MTP1 arthrodeses performed over a 13-year period, 12 feet returned with a painful keratoma beneath a gradually hyperextending interphalangeal joint of the great toe (IPJ1) from unexcised, unrecognized or recognized HIPJS. We identified another 7 feet with HIPJS, which did not develop symptoms after MTP1 arthrodesis. Angles at which arthrodesis had been performed were measured. Results: All big toes had been arthrodesed in good position, clinically and radiologically, with no difference between the two groups in angles subtended by the proximal phalanx of the arthrodesed big toe with the ground. Good outcomes followed surgical excision of the symptomatic HIPJS. Conclusions: The presence of a HIPJS should be excluded in the differential diagnosis of IPJ1 symptoms developing after MTP1 arthrodesis. Furthermore, one should look out for and consider prophylactic excision of a HIPJS at time of MTP1 arthrodesis.