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Bipartite medial hallux sesamoid with sesamoiditis

Case contributed by Vinay V Belaval
Diagnosis certain

Presentation

Right forefoot pain and inability to bear weight for 2 weeks.

Patient Data

Age: 40 years
Gender: Male

Axial bone window images of right foot show bipartite medial hallux sesamoid bone.

The proximal pole of bipartite medial hallux sesamoid bone shows PD fat-sat hyperintense and T1w hypointense signals with mild overlying soft tissue and subcutaneous edema. The overlying flexor tendons show normal signals.

Case Discussion

Radiological features are suggestive of sesamoiditis. An important differential in the setting of trauma is a fracture of a sesamoid bone. Bipartite medial hallux sesamoid is characterized by smooth well-corticated margins with the sum of lengths of both portions being more than the length of lateral hallux sesamoid bone- these features help in differentiating it from a fracture.

Other differentials include early osteonecrosis. No fragmentation of the sesamoid was evident on CT.

Other pathologies affecting the hallux sesamoids are fracture, turf toe (sudden hyperextension related ligamentous injury resulting in proximal migration of the sesamoid) and avascular necrosis.

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