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Accessory Lesser Metatarsal Sesamoids in All of the Metatarsophalangeal Joints

by MASS4D® Prescription Orthotics March 06, 2018


Sesamoid bones of the first metatarsophalangeal joint are considered to be a normal part of the skeleton; however, sesamoid bones at the lesser metatarsals and the hallux interphalangeal joint are rarely seen and are accepted as accessory bones.

The authors presented a unique case report of a 68-year-old woman with accessory sesamoid bones in all of the metatarsophalangeal joints with mild metatarsalgia symptoms.

Physical examination revealed mild metatarsalgia without any callosities on the plantar aspect of the foot.

Other than mild hallux valgus deformity, there were no lesser toe deformities. On standing, the patient had no clinical appearance of pes planus or pes cavus deformity.

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Weightbearing dorsoplantar and nonweightbearing oblique radiographs of the right foot revealed the presence of plantarly located sesamoid bones in all of the lesser metatarsophalangeal joints.

Two ossicles were present under the fourth and fifth metatarsal heads, and a single ossicle was located under the second and third metatarsal heads.

The lengths of the sesamoids were as follows – medial hallux sesamoid, 10.1 mm; lateral hallux sesamoid, 9.0 mm; second metatarsal sesamoid, 6.7 mm; third metatarsal sesamoid, 6.5 mm; medial fourth sesamoid, 6.1 mm; lateral fourth sesamoid, 4.3 mm; lateral fourth sesamoid, 3.9 mm; medial fifth sesamoid, 4.5 mm; and lateral fifth sesamoid, 3.2 mm.

Conservative treatment of the patient included metatarsal padding and footwear modification.

After 3 months of follow-up, the patient’s metatarsalgia was found to be reduced.

In scientific literature, there are studies showing the frequencies of accessory lesser metatarsal sesamoid bones for each metatarsophalangeal joint.

However, this is the first case reporting a patient with lesser metatarsal sesamoids in all of the metatarsophalangeal joints.

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  1. Ergun, S., Saygi, B., Arslan, I., Yildirim, Y. (2017) Accessory Lesser Metatarsal Sesamoids in All of the Metatarsophalangeal Joints. Journal of the American Podiatric Medical Association: May/June 2017, Vol. 107, No. 3, pp. 223-225

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