The Hallucal-Sesamoid Complex: Normal Anatomy, Imaging, and Pathology

Abstract

The first metatarsophalangeal joint and hallucal-sesamoid complex are critical structures in weightbearing and susceptible to several pathologies including turf toe, sesamoiditis, degenerative or inflammatory arthritides, infection, and avascular necrosis. This review article summarizes the complex anatomy of the region, covers common pathologies while clarifying terms such as turf toe and sesamoiditis, reviews imaging techniques, and discusses management.

Keywords

first metatarsophalangeal joint - hallucal-sesamoid complex - turf toe - sesamoiditis

• References

• 1 Theumann NH, Pfirrmann CWA, Mohana Borges AVR, Trudell DJ, Resnick D. Metatarsophalangeal joint of the great toe: normal MR, MR arthrographic, and MR bursographic findings in cadavers. J Comput Assist Tomogr 2002; 26 (5) 829-838
• 2 Resnick D, Niwayama G, Feingold ML. The sesamoid bones of the hands and feet: participators in arthritis. Radiology 1977; 123 (1) 57-62
• 3 Sanders TG, Rathur SK. Imaging of painful conditions of the hallucal sesamoid complex and plantar capsular structures of the first metatarsophalangeal joint. Radiol Clin North Am 2008; 46 (6) 1079-1092 , vii
• 4 McBryde Jr AM, Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med 1988; 7 (1) 51-60
• 5 Dedmond BT, Cory JW, McBryde Jr A. The hallucal sesamoid complex. J Am Acad Orthop Surg 2006; 14 (13) 745-753
• 6 Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis. Foot Ankle Int 1994; 15 (9) 462-470
• 7 Richardson EG. Injuries to the hallucal sesamoids in the athlete. Foot Ankle 1987; 7 (4) 229-244
• 8 Fleischli J, Cheleuitte E. Avascular necrosis of the hallucal sesamoids. J Foot Ankle Surg 1995; 34 (4) 358-365
• 9 Boike A, Schnirring-Judge M, McMillin S. Sesamoid disorders of the first metatarsophalangeal joint. Clin Podiatr Med Surg 2011; 28 (2) 269-285 , vii
• 10 Cohen BE. Hallux sesamoid disorders. Foot Ankle Clin 2009; 14 (1) 91-104
• 11 Weil LS, Hill M. Bipartite tibial sesamoid and hallux abducto valgus deformity: a previously unreported correlation. J Foot Surg 1992; 31 (2) 104-111
• 12 Munuera PV, Domínguez G, Reina M, Trujillo P. Bipartite hallucal sesamoid bones: relationship with hallux valgus and metatarsal index. Skeletal Radiol 2007; 36 (11) 1043-1050
• 13 Crain JM, Phancao J-P, Stidham K. MR imaging of turf toe. Magn Reson Imaging Clin N Am 2008; 16 (1) 93-103 , vi
• 14 Schein AJ, Skalski MR, Patel DB , et al. Turf toe and sesamoiditis: what the radiologist needs to know. Clin Imaging 2015; 39 (3) 380-389
• 15 McCormick JJ, Anderson RB. Turf toe: anatomy, diagnosis, and treatment. Sports Health 2010; 2 (6) 487-494
• 16 Waldrop III NE, Zirker CA, Wijdicks CA, Laprade RF, Clanton TO. Radiographic evaluation of plantar plate injury: an in vitro biomechanical study. Foot Ankle Int 2013; 34 (3) 403-408
• 17 Coker TP, Arnold JA, Weber DL. Traumatic lesions of the metatarsophalangeal joint of the great toe in athletes. Am J Sports Med 1978; 6 (6) 326-334
• 18 Bowers Jr KD, Martin RB. Turf-toe: a shoe-surface related football injury. Med Sci Sports 1976; 8 (2) 81-83
• 19 Rodeo SA, O'Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF. Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med 1990; 18 (3) 280-285
• 20 Karasick D, Schweitzer ME. Disorders of the hallux sesamoid complex: MR features. Skeletal Radiol 1998; 27 (8) 411-418
• 21 Taylor JAM, Sartoris DJ, Huang G-S, Resnick DL. Painful conditions affecting the first metatarsal sesamoid bones. Radiographics 1993; 13 (4) 817-830
• 22 Aseyo D, Nathan H. Hallux sesamoid bones. Anatomical observations with special reference to osteoarthritis and hallux valgus. Int Orthop 1984; 8 (1) 67-73
• 23 Roukis TS, Weil LS, Weil LS, Landsman AS. Predicting articular erosion in hallux valgus: clinical, radiographic, and intraoperative analysis. J Foot Ankle Surg 2005; 44 (1) 13-21