J Korean Soc Radiol.  2013 Oct;69(4):311-315. 10.3348/jksr.2013.69.4.311.

Congenital Hypoplasia of the Medial Hallucial Sesamoid with Avascular Necrosis: A Case Report

• Song Y
• Lee S
• Choi CB
• Joo KB
• Ryu JA
• Bae J

• KMID: 2041953
• DOI: http://doi.org/10.3348/jksr.2013.69.4.311

Abstract

Avascular necrosis of the hallucial sesamoids is an uncommon cause of metatarsalgia, and the congenital absence of the medial sesamoid is also a rarely reported condition in the podiatric literature. It must be distinguished from other painful conditions of the sesamoid due to the opposite direction of treatment. To our knowledge, there is no reported case of congenital hypoplasia of the medial sesamoid with osteonecrosis. We report a case of nontraumatic metatarsal pains with progressive sclerosis and fragmentation of the medial sesamoid on serial radiographs, magnetic resonance imaging, and ultrasonography with an incidental finding for the absence of contralateral medial sesamoid in a 33-year-old female.

MeSH Terms

Adult
Female
Humans
Incidental Findings
Magnetic Resonance Imaging
Metatarsal Bones
Metatarsalgia
Necrosis
Osteonecrosis
Sclerosis
Sesamoid Bones

Figure

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  Fig. 1 Plain radiographs of the right foot who a 33-year-old woman with plantar pain to the right first metatarsophalangeal joint. A comparison of two radiographs at interval changes of a year; the medial sesamoid collapsed and had more areas of demineralization with fragmentation. A. Initial right lateral ankle radiograph at the outside hospital demonstrates flattening of the medial sesamoid with sclerosis (arrow). B. A year after initial lateral radiograph demonstrates a more collapsed medial sesamoid with increased areas of demineralization (arrow). C. An additional sesamoid view demonstrates the absence of the left medial sesamoid (arrows) and hypoplasia of the right medial sesamoid (arrows) with fragmentation and adjacent soft tissue swelling.

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  Fig. 2 Ultrasonography of the right foot. A. A transverse scan shows multiple echogenic nodules of the medial sesamoid (arrow) with fragmentation. B. A longitudinal scan shows an irregular surface of the medial sesamoid (arrow) with multiple echogenic nodules.

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  Fig. 3 Magnetic resonance image (MRI) of the right foot. A. T1-weighted coronal MR image demonstrates the low signal intensity of the right medial sesamoid (arrow). B. T2-weighted coronal MR image demonstrates heterogenously low to intermediate signal intensity with fragementation of the right medial sesamoid (arrow). C. On gadolinium enhanced, fat-suppressed T1-weighted coronal MR image demonstrates patchy localized signal enhancement seen within the medial sesamoid (arrow). These findings reflect avascular necrosis of the medial sesamoid.

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