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French M, Thorhauer ED, Kimura T, Sangeorzan BJ, Ledoux WR. Displacement of the Metatarsal Sesamoids in Relation to First Metatarsophalangeal Joint Extension. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221126457. [PMID: 36185347 PMCID: PMC9520144 DOI: 10.1177/24730114221126457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Quantifying normal sesamoid movement in relation to first metatarsophalangeal joint (MTPJ1) motion is essential to identifying aberrant kinematics and understanding how they may contribute to forefoot pain and dysfunction. The present study aims to report sesamoid displacement in relation to MTPJ1 extension and to compare sesamoid displacement with MTPJ1 range of motion (ROM) from several imaging modalities. Methods: Using 10 fresh frozen cadaveric feet, sesamoid displacement was evaluated during simulated MTPJ1 extension. The ability of 3 MTPJ1 measurement techniques (goniometry, fluoroscopy, and unloaded cone beam computed tomography [CBCT]) in predicting sesamoid displacement were compared. Kinematics were expressed in a coordinate frame based on the specimen-specific first metatarsal anatomy, and descriptive statistics are reported. Results: In the sagittal plane in both neutral and maximally extended positions, the tibial sesamoid was located on average more anteriorly than the fibular sesamoid. The angular displacement of the tibial and fibular sesamoids in the sagittal plane were 30.2 ± 14.3 degrees and 35.8 ± 10.6 degrees, respectively. In the transverse plane, both sesamoids trended toward the body midline from neutral to maximum extension. The intersesamoidal distance remained constant throughout ROM. Of the 3 measurement techniques, MTPJ1 ROM from CBCT correlated best (R2 = 0.62 and 0.81 [P < .05] for the tibial and fibular sesamoid, respectively) with sagittal plane sesamoid ROM. Conclusion: The sesamoids were displaced anteriorly and medially in relation to increasing MTPJ1 extension. CBCT was the most correlated clinical imaging technique in relating MTPJ1 extension with sesamoid displacement. Clinical Significance: This study advances our understanding of the biomechanical function of the sesamoids, which is required for both MTPJ1 pathology interventions and implant design. These findings support the use of low-dose CBCT as the information gathered provides more accurate detail about bone position compared with other imaging methods.
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Affiliation(s)
- Mackenzie French
- School of Medicine, University of Washington, Seattle, WA, USA
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, WA, USA
| | - Eric D. Thorhauer
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, WA, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Tadashi Kimura
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, WA, USA
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Bruce J. Sangeorzan
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, WA, USA
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
| | - William R. Ledoux
- RR&D Center for Limb Loss and MoBility (CLiMB), VA Puget Sound, Seattle, WA, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA
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Hallinan JTPD, Statum SM, Huang BK, Bezerra HG, Garcia DAL, Bydder GM, Chung CB. High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization. Radiographics 2020; 40:1107-1124. [PMID: 32412828 DOI: 10.1148/rg.2020190145] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first metatarsophalangeal joint (MTPJ) is vital to the biomechanics of the foot and supports a weight up to eight times heavier than the body during athletic activities. The first MTPJ comprises osseous and cartilaginous surfaces along with a complex of supporting structures, including the dorsal extensor tendons, collateral ligaments, and a plantar plate complex. In contradistinction to the lesser MTPJ plantar plates, a single dominant fibrocartilaginous capsular thickening does not exist at the first MTPJ. Instead, the plantar plate complex comprises a fibrocartilaginous pad that invests the hallux sesamoids and is inseparable from the plantar capsule, the intersesamoid ligament, paired metatarsosesamoid and sesamoid phalangeal ligaments (SPLs), and the musculotendinous structures. Acute injury at the first MTPJ is typically secondary to forced hyperextension-turf toe-and can involve multiple structures. During hyperextension, the resulting forces primarily load the distal SPLs, making these structures more susceptible to injury. SPL injuries are best seen in the sagittal plane at MRI. Radiography can also aid in diagnosis of full-thickness SPL tears, demonstrating reduced sesamoid excursion at lateral dorsiflexed (stress) views. Hallux valgus is another common condition, resulting in progressive disabling deformity at the first MTPJ. Without appropriate treatment, first MTPJ injuries may progress to degenerative hallux rigidus. The authors detail the anatomy of the first MTPJ in cadaveric forefeet by using high-resolution 3-T and 11.7-T MRI and anatomic-pathologic correlation. Injuries to the plantar plate complex, collateral ligaments, and extensor mechanism are discussed using clinical case examples. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- James T P D Hallinan
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Sheronda M Statum
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Brady K Huang
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Higor Grando Bezerra
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Diego A L Garcia
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Graeme M Bydder
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
| | - Christine B Chung
- From the Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, 119074 Singapore (J.T.P.D.H.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (J.T.P.D.H.); Department of Radiology, VA San Diego Healthcare System, San Diego, Calif (S.M.S., G.M.B., C.B.C.); Department of Radiology, San Diego Medical Center, University of California, San Diego, Calif (B.K.H., C.B.C.); Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil (H.G.B.); and Universidade Federal de São Paulo, São Paulo, Brazil (UNIFESP) and Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil (D.A.L.G.)
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