Foot and Ankle Radiology by Christman Robert

Author:Christman, Robert
Language: eng
Format: epub
Publisher: LWW
Published: 2014-10-26T16:00:00+00:00

FIGURE 17-29. Osteochondral injury of the first metatarsal head. The arrow identifies a lucent subchondral defect.

FIGURE 17-30. Osteonecrosis of the fibular sesamoid. A: Dorsoplantar view. B: Sesamoid axial view. Findings include significant fragmentation, deformity, and sclerosis with mixed rarefaction.

Osteochondral injury has also been reported along the first metatarsal head articular surface (Figure 17-29). It is considered to be a precursor to hallux rigidus.147,148 There also is a high prevalence of osteochondral lesions in patients undergoing surgical hallux valgus correction.149

Sesamoids (First Metatarsophalangeal Joint)

Renander150 was the first to report osteonecrosis of a first metatarsal sesamoid, which he described as an osteochondropathy. Osteonecrosis of the hallucal sesamoid bones is a relatively rare disorder, with unclear prevalence.151,152 This true osteonecrosis occurs most commonly in young adult women (second and third decades of life),153,154 with a precipitating history of minor forefoot trauma.150–152,155,156 There is no agreement on which sesamoid is most frequently affected. Some authors claim that it afflicts both equally157–159; some argue that greater incidence is in the tibial sesamoid160 while others report a higher rate of fibular injury.153,161

According to Jahss,162 radiographic evidence of sesamoid osteonecrosis may not be evident until 9 to 12 months after the initial onset of symptoms; however, Ogata et al.163 reported four cases that all appeared within 6 months. When visible, findings include fragmentation, mottling (acute osteopenia), irregular shape, and geode formation, followed by sclerosis, collapse, flattening and widening (Figure 17-30).151,153,163 Radiographs may be difficult to interpret due to the superimposition of other bone structures in most views.153 The sesamoid axial view is best for isolating the sesamoids and usually shows fragmentation of the affected bone.164,165

The three-phase bone scan is useful in diagnosing true osteonecrosis, when diagnosis is unclear; however, MRI is a more specific modality to diagnose sesamoid disorders.164 At present, MRI is the most sensitive noninvasive diagnostic method available, enabling differentiation from other sesamoid pathologies.153,166

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