Bilateral osteochondritis of the medial hallucial sesamoids in a 12-year-old

摘要

We report an unusual case of bilateral osteochondritis of the tibial (medial) hallucial sesamoids in a 12-year-old rugby player. He was referred with an 18 month history of disabling bilateral plantar first metatarsophalangeal joint pain that did not respond to conservative treatment. The diagnosis of sesamoid osteochondritis is usually delayed because radiological changes do not occur for up to twelve months following the onset of symptoms. Diagnostic radiological changes are best seen on axial sesamoid plain radiographs and computerized tomograms. It is difficult to differentiate between sesamoiditis and true or stress fractures of the sesamoid. The initial treatment of clinical sesamoiditis is conservative. In this case bilateral medial hallucial sesamoidectomy provided complete and sustained relief of symptoms. At 6 month follow up the boy remains symptom free and has returned to normal sporting activity.