Kanatli Ulunay, Ozturk Akif Muhtar, Ercan Nil Gulizar Tokgoz, Ozalay Metin, Daglar Bulent, Yetkin Haluk
Department of Orthopedics and Traumatology, Gazi University, Ankara, Turkey.
Clin Anat. 2006 Oct;19(7):634-9. doi: 10.1002/ca.20282.
Pain at the first metatarsophalangeal (MTP) joint can result from inflammation, chondromalacia, flexor hallucis brevis tendinitis, osteochondritis dessecans, fracture of a sesamoid bone, avascular necrosis of sesamoids, inflamed bursae, intractable keratoses, infection, sesamoiditis, gout arthropathy, and rheumatoid arthritis. Congenital absence of a sesamoid bone is extremely rare. We present a 17-year-old male patient with pain at the plantar aspect of the right MTP joint associated with congenital absence of the medial sesamoid. There was tenderness and the range of motion was minimally restricted. He described the pain as necessitating changes in his social life. On radiographs, the medial hallucial sesamoid was absent on the right side. The MTP joint was also evaluated using magnetic resonance imaging (MRI). A metatarsal pad was prescribed and the patient was satisfied with the treatment at the 2 months follow-up period. MRI revealed no pathological tissue at the medial sesamoid site. Hallucial sesamoids absorb pressure, reduce friction, protect the tendons, act like a fulcrum to increase the mechanical force of the tendons, and provide a dynamic function to the great toe by elevating first metatarsal head. Congenital absence of these bones is very rare but we must consider it in a patient with MTP joint pain.
第一跖趾（MTP）关节疼痛可能由炎症、软骨软化、拇短屈肌腱炎、剥脱性骨软骨炎、籽骨骨折、籽骨缺血性坏死、滑囊炎、顽固性角化病、感染、籽骨炎、痛风性关节炎和类风湿性关节炎引起。先天性籽骨缺失极为罕见。我们报告一名17岁男性患者，其右MTP关节足底侧疼痛，伴有内侧籽骨先天性缺失。有压痛，活动范围轻度受限。他描述疼痛使他的社交生活发生了改变。X线片显示右侧内侧拇籽骨缺失。还使用磁共振成像（MRI）对MTP关节进行了评估。开具了跖骨垫，患者在2个月随访期对治疗满意。MRI显示内侧籽骨部位无病理组织。拇籽骨可吸收压力、减少摩擦、保护肌腱、起到支点作用以增加肌腱的机械力，并通过抬高第一跖骨头为拇趾提供动态功能。这些骨头的先天性缺失非常罕见，但对于MTP关节疼痛的患者我们必须考虑到这种情况。
