Presentation Type
Poster Presentation
Category
STEM (science, technology, engineering, mathematics)
Abstract/Artist Statement
Background: The foot contains two sesamoid bones including a medial tibial sesamoid and lateral fibular sesamoid bone, in which both are embedded in the plantar ligament beneath the first metatarsal head. Medial sesamoid fractures are rare and are often misdiagnosed. Radiographs may be inconclusive because a bipartite sesamoid may be present (sesamoid bone is naturally divided into two segments). Sesamoid fractures usually occur due to forced hyperextension of the great toe and metatarsophalangeal (MTP) joint. Sesamoid fractures are often missed on initial diagnosis because the clinical presentation is similar to a turf toe injury. Pain in the ball of the foot and first metatarsophalangeal joint, swelling, and limited plantarflexion/dorsiflexion are common clinical signs of a sesamoid fracture.
Patient: A 21-year-old male division one collegiate football athlete was initially diagnosed with turf toe. The athlete complained of persistent pain with activities that required pushing off after their foot was stepped on while running during a drill. Initial clinical examination showed no signs of deformity, structural trauma or abnormalities. After failed management, MRI imaging was obtained, which revealed a medial sesamoid fracture and partial tearing of the flexor hallucis tendons.
Intervention or Treatment: After the initial diagnosis, conservative management consisted of rehabilitation exercises and turf toe taping techniques. Activity modification, total rest, and the use of anti-inflammatories were also utilized. When these strategies did not effectively manage the condition, metal plated inserts were added to the athlete’s shoes to increase rigidity. Eventually after the sesamoid fracture diagnosis, surgical resection of the fractured sesamoid and repair of the flexor hallucis tendons was performed.
Outcomes: Complete resolution of signs and symptoms occurred following surgical resection of fractured sesamoid and surgical repair of torn flexor tendons.
Conclusions: Medial tibial sesamoid fractures rarely occur. Conservative management may not always be effective and surgical interventions, such as resection or screw fixation have been described. Successful return to sport and improved patient function have been reported in literature following surgical intervention.
Clinical Bottom Line: Medial tibial sesamoid bone fractures are rare and commonly missed on diagnosis. Radiographs may not detect the fracture, therefore other imaging, such as MRI or CT scan, may be warranted to accurately assess the injury.
Mentor Name
Valerie Moody
Medial Tibial Sesamoid Bone Fracture of the Foot in a Collegiate Football Player: A Case Study
UC North Ballroom
Background: The foot contains two sesamoid bones including a medial tibial sesamoid and lateral fibular sesamoid bone, in which both are embedded in the plantar ligament beneath the first metatarsal head. Medial sesamoid fractures are rare and are often misdiagnosed. Radiographs may be inconclusive because a bipartite sesamoid may be present (sesamoid bone is naturally divided into two segments). Sesamoid fractures usually occur due to forced hyperextension of the great toe and metatarsophalangeal (MTP) joint. Sesamoid fractures are often missed on initial diagnosis because the clinical presentation is similar to a turf toe injury. Pain in the ball of the foot and first metatarsophalangeal joint, swelling, and limited plantarflexion/dorsiflexion are common clinical signs of a sesamoid fracture.
Patient: A 21-year-old male division one collegiate football athlete was initially diagnosed with turf toe. The athlete complained of persistent pain with activities that required pushing off after their foot was stepped on while running during a drill. Initial clinical examination showed no signs of deformity, structural trauma or abnormalities. After failed management, MRI imaging was obtained, which revealed a medial sesamoid fracture and partial tearing of the flexor hallucis tendons.
Intervention or Treatment: After the initial diagnosis, conservative management consisted of rehabilitation exercises and turf toe taping techniques. Activity modification, total rest, and the use of anti-inflammatories were also utilized. When these strategies did not effectively manage the condition, metal plated inserts were added to the athlete’s shoes to increase rigidity. Eventually after the sesamoid fracture diagnosis, surgical resection of the fractured sesamoid and repair of the flexor hallucis tendons was performed.
Outcomes: Complete resolution of signs and symptoms occurred following surgical resection of fractured sesamoid and surgical repair of torn flexor tendons.
Conclusions: Medial tibial sesamoid fractures rarely occur. Conservative management may not always be effective and surgical interventions, such as resection or screw fixation have been described. Successful return to sport and improved patient function have been reported in literature following surgical intervention.
Clinical Bottom Line: Medial tibial sesamoid bone fractures are rare and commonly missed on diagnosis. Radiographs may not detect the fracture, therefore other imaging, such as MRI or CT scan, may be warranted to accurately assess the injury.