Sesamoid bones. Sesamoid bones - ossa sesamoidea

Proximal sesamoid bones– ossa sesamoidea proximalis

There are two on each finger and are located on the palmar surface of the metacarpophalangeal joint.

Distal sesamoid bones– ossa sesamoidea distalis

One on each finger is located on the palmar surface of the distal interphalangeal joint.

Dorsal sesamoid bones– ossa sesamoidea dorsalis

They are located on the dorsal surface of the metacarpophalangeal joint.

Questions to consolidate the material studied:

What bones does the forearm include?

What units is the skeleton of the hand divided into?

What are the differences between the epiphyses and diaphysis of the radius?

Explain the structure of the ulna bone.

Name the specific features of the bones of the forearm of a dog, pig, cattle, horse.

By what signs can you determine whether you have a right or left forearm?

How many rows of wrist.

What bones are distinguished in the proximal row?

What bones are distinguished in the distal row?

Name the specific features of the carpal bones of a dog, pig, cattle, horse.

What are the differences between the epiphyses and diaphysis of the metacarpal bone?

Name the specific features of the metacarpal bones of dogs, pigs, cattle, and horses.

How many phalanges do the fingers have?

How do the first and second phalanx differ in structure?

Name the specific features of the bones of the fingers of a dog, pig, cattle, horse.

Literature:

Akaevsky A.I. “Anatomy of Domestic Animals” M. 1975. P85-92.

Klimov A.F. "Anatomy of Pets", 2003. Part 1. From 179-189.

Khrustaleva I.V., Mikhailov N.V. and others. “Anatomy of Domestic Animals” M. Kolos. 1994. pp. 128-154.

Popesco P. “Atlas of topographic anatomy of agriculture. animals." "Bratislava". 1961 T. 3.

Yudichev Yu.F. "Comparative Anatomy of Domestic Animals". Volume 1. Orenburg-Omsk. 1997. pp. 143-151.

Yudichev Yu.F., Efimov S.I. “Anatomy of Domestic Animals” Omsk. 2003. pp. 126-133.

Appendix, Fig. 24 – 25.

Bones of the pelvic limb.

The bones of the pelvic limb - ossa membri pelvini - are represented by the bones of the girdle of the pelvic limb (ilium, pubis, ischium) and the bones of the free section (femur, bones of the leg and foot).

The bones of the girdle of the pelvic limb, together with the sacrum and the first caudal vertebrae, form the pelvic cavity - cavum pelvis, which has a cylindrical or cone shape. The entrance to the pelvic cavity lies between the sacral, ilium and pubic bones, and the exit from the pelvic cavity lies between the ischial and first caudal vertebrae.

3.3. Pelvic girdle and femur.

The girdle of the pelvic limb - cingulum membri pelvini - is represented by the paired pelvic bone. Ventrally, both pelvic bones, connected to each other by the pelvic suture, form the pelvis.

Target:

To study the structure and specific features of the bones forming the pelvic girdle.

To study the structure and specific features of the bones of the free part of the pelvic limb: the femur.

Educational visual aids:

1. Tables - bones of the peripheral skeleton of domestic animals and birds

2. Skeletons of domestic animals and birds.

3. Pelvic and femur bones of a dog, pig, cattle, horse.

Teaching method:

1. There are four sets of study materials on the students’ tables.

2. On the teacher’s table there are demonstration preparations and a set of training preparations.

3. Tables are posted on the board and Latin terms are recorded.

4. The teacher explains the content of the lesson (35 min)

5. Independent work of students (30 min)

6. Checking the quality of assimilation of the studied material (10 min)

7. Answers to questions and homework (5 min).

Familiarize yourself with the general structure of the bones of the pelvic limb.

Study the structure of the pelvic and femoral bones, as well as species characteristics in various species of domestic animals and birds.

Pelvic girdle –cingulummembripelvini

Hip bone -oscoxae

Pelvic symphysis –symphysispelvina

Pelvis –pelvis

Pelvic bone – os coxae

locked hole – foramen obturatum

glenoid cavity – acetabulum

edge – margo acetabuli

fossa – fossa acetabuli

tenderloin – incisura acetabuli

semilunar surface – facies lunata

ischial spine – spina ischiadica

greater sciatic notch – incisura ischiadica major

minor sciatic notch – incisura ischiadica minor

entrance to the pelvis – apertura pelvis cranialis

exit from the pelvis – apertura pelvis caudalis

Ilium – os ilium

body – corpus ossis ilii

iliopubic crest – crista iliopectinea

lumbar tubercle – tuberculum psoas minor

wing – ala ossis ilii

iliac crest – crista iliaca

maklok – tuber coxae

sacral tubercle – tuber sacrale

gluteal surface – facies glutea

gluteal line – linea glutea

sacropelvic surface – facies sacropelvina

iliac surface – facies iliaca

iliac roughness – tuberositas iliaca

auricular surface – facies auricularis

Ischium – os ischium

body – corpus ossis ischii

plate – tabula ossis ischii

branch – ramus ossis ischii

ischial tuberosity – tyber ischiadica

ischial arch – arcus ischiadica

Pubis bone – os pubis

body – corpus ossis pubis

cranial branch – ramus cranialis ossis pubis

caudal branch – ramus caudalis ossis pubis

suture surface – facies symphysialis

crest of pubic bone - pecten ossis pubis

iliopubic eminence – eminentia iliopubica

dorsal pubic tubercle – tuberculum pubicum dorsale

ventral pubic tubercle – tuberculum pubicum ventrale

Species features:

Dog. The iliac crest is convex, the marrow is directed ventrally, the psoas minor muscle tubercle is absent, the gluteal surface bears a spoon-shaped depression, the ischial spine is low, the ischial arch is flat, the ischial tubercle is lamellar, the sciatic notch minor is flat, the exit is larger than the entrance.

Pig. The iliac crest is convex, the wing of the ilium is located more vertically, the gluteal surface has a crest, the ischial spine is high, with tuberosity, the sciatic notch and arch are deep, the ischial tubercle has a lateral process, the entrance is equal to the exit.

Cattle. The gluteal surface is concave, the gluteal line runs closer to the lateral edge, the ischial spine is high, the ischial tuberosity has three tubercles, the entrance is equal to the exit.

Horse. The iliac crest is weakly concave, the marrow is massive, tuberous, the ischial tubercle is lamellar, with two tubercles, the fossa and notch of the glenoid cavity are deep, the inlet is larger than the outlet.

I am 30 years old, I try to play sports whenever I have time, football, kickboxing, the gym. An injury occurred while playing football, I hit it hard either on the heel of the other foot, or caught it on the ground, with my thumb or the upper part of the 1st metatarsal bone, in general, the place where they hit the ball, or with my finger on a kink down under the foot. It's hard to say, there was a click and a sharp pain. Literally immediately I began to attack and felt clicks in this area and it hurt to shoot. I went to a nearby trauma center, took a picture, the doctor said that there were 3 sesamoid bones in the picture, those under the 1st metatarsal bone, but there should be 2 of them, they say, it means that there is a fracture of one sesamoid bone. As a result, they applied a plaster splint along the bottom of the foot with an instep from the back to the middle of the calf.
Then I slept heavily for a couple of nights, nagging pain, but on the third day it became easier. I went with the photo from the first injury to the trauma center at my place of residence, where the doctor took a new photo and said that there were no differences in both images, but he still didn’t see a fracture of this bone. He said that a sesamoid fracture usually occurs if something heavy falls, but given my description of the nature of the blow, this is difficult to imagine. Further, he did not particularly discuss his decision with me. They wrapped this splint back, and prescribed applying ointment, and wrapping the splint better with an elastic bandage after smearing it.

Now 5 days have passed, it has become easier, I can already step on the right (outer) side of the foot, the splint from the very beginning goes back and forth along the axis, and moves left and right along the ankle area, so I don’t see much difference in what to wrap bare leg tightly elastic. with a bandage that is in a cast, the cast is only better against unexpected blows, and at night. And the area where it hurts in the area of ​​the metatarsus and toe does not feel affected there. At home I removed the plaster cast and periodically wrap it with an elastomer bandage. And so the leg is just resting naked in ointments. Today, on the 5th day, I carefully walked 50m to the store without a cast, I carefully step on the outer edge of my foot, and it doesn’t hurt much. Of course, if you step on it completely it will hurt. I can’t touch my thumb, but I can move it.

Which is why I'm confused about who to believe...
1) what are the differences in the treatment of sprains (bruises) of the ligaments and metatarsus joint from a fracture of the sesamoid bone, what is the risk of such an error in diagnosis if I do have a fracture?
2) does it make sense to go to the Institute of Traumatology to see specialists in the legs, or is there not much difference in treatment, a splint and rest for 3-4 weeks for the leg?
3) Is synthetic plaster placed only circularly? Or can it be made like a splint so that it can be removed? I seem to have come across that there are synthetic splints like this.
4) I read in medical literature that there are cases when there is congenital bifurcation of the sesamoid bones, I believe the 2nd doctor understood my 3 bones as congenital. It makes me wonder, to be sure, wouldn’t it be worth taking a picture of a healthy foot?
5) I have a predisposition to arthritis, I think by genes, from my parents, at the age of 20, I had reactive arthritis of this particular joint of the 1st metatarsus and toe, then they gave me an intra-articular injection and after 2-3 days everything went away.

ZY In both injuries they offered to put synthetic plaster at a price of 3500 rubles. Is this an adequate price?... I don’t mind for the sake of convenience, but I remember a friend for 1700-2000 rubles installed a plastic one up to the knee, and I have a splint up to the middle of my calf, and even 3500, why I don’t understand why it’s more expensive... in a paid clinic according to the price list It seems to cost about 3300 rubles with materials, through the cash register... I checked in the orthopedic store, the orthopedic traumatologist who was on duty there said that you only need a couple of strips of this synthetic bandage 10x3.6, priced at 500-600 rubles, and for the work 500 -1000r. In total, no more than 2 thousand will come out. But I did not specify whether it would be circular or as a splint.

Scan of the 1st image, taken 1 hour after the injury

Let me remind you that the forefoot consists of: pentatarsal bones, two phalanges of the big toe and three phalanges of each of the other toes, joints, soft tissues (muscles, cartilage, tendons), nerves and various vessels.

The forefoot is your workhorse, as it is in contact with the ground 75% of the time while walking and running. This means that it bears the main load and shocks.

The heel and midfoot are a strong, inactive bone structure, while the forefoot contains 21 bones that are very intricately connected to each other, which allows the leg to move forward. Therefore, it is not surprising that various problems arise much more often in this area of ​​the foot, and when the weight is distributed, most of it falls on it. It seems that this system is very fragile, but nevertheless, only 5% of the population breaks a finger at least once in their life and less than 1% breaks a metatarsal bone. This is simply amazing, especially considering what klutzes we are and how little we care about making our shoes comfortable.

The most common diseases of the forefoot are various types of calluses, which we will discuss in another chapter. There are other problems, more interesting and complex, and I will tell you about them below. They include inflammation of joints, ligaments, cartilage and nerve tissue, but have little to do with bone damage.

Typically, when a patient complains of pain in the forefoot, the doctor makes a diagnosis of “metatarsalgia.” Probably many people are scared by a word that sounds so threatening and mysterious. But metatarsalgia simply means pain in the metatarsal area. In general, the doctor simply agrees with the patient that his legs hurt.

If you, for example, went to a therapist and said that you have a stomach ache, would you calm down if the doctor wrote “sick stomach” in the diagnosis? I think not, especially if the doctor said that the cause is unclear and we need to do an operation to find out what is wrong. It's the same with the legs. Do not be complacent about the diagnosis of “metatarsalgia”; these are just general words. If your doctor tells you that the pain will go away on its own, will not go away at all, or that you need surgery, run away from his office, if you still can, of course. Contact a specialist.

The cause of pain can be joint inflammation, bone damage, and a number of soft tissue problems. Treatment is of course different for each case. Remember that pain in this part of the foot rarely indicates any serious illness and is easy to treat.

It is very difficult to make an accurate diagnosis when the patient complains of pain in the metatarsal bones. The symptoms of many diseases are very similar, and it takes a real specialist to understand what happened this time. Let's look at one case from my practice.

One of the causes of pain may be foot deformation caused by a downward displacement of the head of the metatarsal bone (see Fig. 2.3 and Fig. 6.1), which is always lowered, although it should move up and down while walking. The main reason for her immobility is damage to the metatarsophalangeal joint. The head of the damaged bone is lower than the rest, so it is always subjected to too much stress. The disease is aggravated by uncomfortable shoes, especially shoes with thin soles, since they practically do not absorb shock while walking or running. But if pain occurs in the area of ​​the metatarsal head, then even the most comfortable shoes are unlikely to help you. Only complete elimination of the causes of the disease can relieve joint inflammation.

The heads of the metatarsal bones and proximal phalanges of the toes form the metatarsophalangeal joints. Deformations leading to plantar displacement of the bones cause inflammation and further damage to the joint, capsulitis and synovitis develop. The articular capsule, attached near the articular ends of the articulating bones, forms a closed articular cavity. The capsule consists of two layers: the outer one is dense fibrous tissue, the inner one is formed by a synovial membrane, which lines the fibrous layer from the inside and continues on the surface of the bone, not covered with cartilage. Inflammation of these tissues is called capsulitis and synovitis, respectively. In our case we are talking about the phalangometatarsal joint.

The main symptom of these diseases is pain in the joint area, especially when your foot steps on a stone: it seems to you that you have a huge bruise on your sole. Unfortunately, similar sensations also occur with neuroma (we will discuss this nerve disease a little below). This happens because the inflamed area is located near the nerve canal. Victims of this disease often complain that the suffering only intensifies when they sit or lie down, sometimes people even wake up at night with severe pain in the foot. This occurs due to the appearance of swelling around the inflamed area. When walking, the swelling decreases somewhat and does not put pressure on the area where the nerve passes. At night, nothing prevents swelling from forming around the joint, and it compresses the tissue surrounding the nerve canal. This is what causes severe pain.

Our old friend, overpronation, is the main cause of these metatarsal diseases as well. Unlike the special case of displacement of the metatarsal bone to the sole, which causes deformation of only their heads, biomechanical disorders extend to the entire foot.

As you now know, when walking, weight is gradually redistributed from the metatarsus to the little toe, and then further to the big toe. Each metatarsal bone takes the load at a certain period of the stepping cycle. This means that when you walk or run, each bone consistently withstands the load of your entire body. The load is placed on each head of the bone with every step.

Remember that when you pronate, your leg “rolls” from the outside to the inside. Something must stop this movement, otherwise our gait would look very strange, we would twist our leg with every step. The purpose of the thumb is to stop this movement, at this point the foot widens and the toe is positioned at a slight angle. The first and second metatarsals together absorb the excess force that turns the foot inward, and rolling stops. If pronation is impaired, then the load on these bones is too great, and the joints become inflamed and the big toe bends more. In this way, a “bone” is gradually formed.

This action can cause pain in the second metatarsal area. The symptoms of this pathology are also very similar to those described earlier. To make life even more difficult for a doctor, it often happens that a person suffers from several diseases at once. The heads of the bones are located so close to the nerve canals that one disease can cause another. For example, inflammation of the metatarsophalangeal joint causes swelling of the nerve, which reduces the diameter of the nerve canal and leads to the development of neuroma. And the symptoms of these two diseases are the same. Therefore, it can sometimes be difficult to make a diagnosis and prescribe the correct treatment.

There is debate among doctors about what appears first – bone inflammation or neuroma. From my point of view, inflammation of the bone necessarily causes a neuroma; the reverse process is also possible, but this happens much less often.

During my practice, I have learned well how to make diagnoses in such cases. And modern ultrasound equipment now allows us to examine the site of inflammation. Also important is the examination of an experienced specialist, who will make a diagnosis based on palpation (feeling the sore spot) and identifying symptoms characteristic of neuroma.

How to cure pain in the metatarsal bones caused by disturbances in biomechanics? You guessed it - with the help of orthopedic insoles and shoes, as well as anti-inflammatory pills and injections. Currently, laser therapy methods are also used. Although the pain is caused by improper load distribution when walking, regular orthopedic insoles will not help. I used to think that even if you wear such insoles since childhood, such diseases will not disappear. But after computerized gait analysis became available to us, I changed my mind and think that metatarsal problems can be solved with specially designed shoes. According to our observations, after a few years patients recover completely. I hope that these data will be fully confirmed over time.

Surgery may be the last resort for people suffering from forefoot pain. Moreover, if the head of the bone is too far displaced towards the sole and leads to the formation of bone calluses, then an osteotomy (surgery aimed at eliminating the deformity or improving the function of the musculoskeletal system by artificially breaking the bone) is the only way to permanently solve the problem. This operation is actually not as terrible as it is described. It gives excellent results with very little recovery time - of course, if you follow the doctor's instructions.

Of course, osteotomy can lead to some complications, regardless of whether it concerns the metatarsals or any other bones of the body. The main complication is non-fusion of bones, the integrity of which is disrupted during surgery. Under normal conditions, the ends of the broken bone heal after a certain time, and it becomes completely normal from a biomechanical point of view, that is, it does not put unnecessary pressure on the metatarsal head.

Another problem is sometimes explained by the fact that the "floating" (moving) end of the bone can become abnormally high and negatively impact the adjacent metatarsal bone. If, for example, the movable end of the second metatarsal bone is located so high that its head no longer supports weight, then when walking quickly, all the weight falls on the head of the third metatarsal bone. As a result, due to excessive stress, it becomes inflamed, which over time may also require treatment and even a new osteotomy. After osteotomy this occurs in 20% of cases. However, if the surgeon connects the site of the surgical violation of the integrity of the bone with a pin, then the bone will heal at the desired angle without interfering with the adjacent bones of the foot.

A neuroma is a benign nerve tumor caused by abnormal growth of nerve cells in response to irritation. I want to emphasize that a forefoot neuroma is nothing more than an irritated pinched nerve that, due to constant compression, causes pain between the metatarsal heads or at the base of the proximal phalanges (the largest bones in the toes). In Fig. Table 4.1 shows the areas where neuromas most often develop.

A neuroma appears if the impaired biomechanics of the foot provokes irritation of the nerve, thereby triggering the growth of additional nerve cells. The “extra” nerve tissue is the body’s attempt to protect the nerve from further irritation, but a vicious circle ensues and the exact opposite happens. The overgrown nerve tissue takes up space and increases irritation because it is even closer to the offending bone.

The severely inflamed nerve then produces even more extra tissue, narrowing the channel through which it passes. This carousel spins until its lucky owner seeks medical help, unable to bear the discomfort that has arisen.

The second probable cause of neuroma, often associated with the first, is wearing uncomfortable shoes that compress the forefoot and force it to take on almost the entire body weight when walking and running. And the biggest blame here lies with high-heeled shoes. The third possible cause is swelling of the foot, compressing the nerve canal from the outside. The fourth, less common reason is an abnormality in the structure of the bone or its growth that pinches the nerve in an area that is usually free for its passage.

In addition to the reasons listed above, there are two theories that explain the origin of neuroma from a scientific point of view. The first of these states that there is a difference in the way the second and third metatarsals connect (to form a joint) with the underlying cuneiform bones, and the fourth and fifth metatarsals with the cuboid bone (see Fig. 4.1).

The II and III metatarsals form a rigid connection with the corresponding wedge-shaped bones; The IV and V metatarsal bones are movably connected to the cuboid bone. In a certain sense, the IV and V metatarsals “float”, while the functioning of the IV bone, in contrast to the rigid third bone, consists of a shearing effect on the space between the third and fourth bones. As the fourth metatarsal moves downward, it crosses the area of ​​the nerve. Naturally, the nerve can become inflamed, leading to the development of a neuroma.

To understand the second theory, you need to imagine how the posterior tibial nerve travels. It is located on the back of the leg, and in the foot area it branches into the medial and lateral plantar nerves. The medial nerve runs along the sole towards the big toe, and the lateral nerve runs towards the little toe.

Reaching the metatarsal bones, the medial plantar nerve branches. Moreover, one branch passes through the first gap between the fingers, the second through the second and the third through the third. The lateral plantar nerve bifurcates, and one of its branches passes through the third space, and the second through the fourth. If you've been counting, you'll realize that there are two separate tiny nerves running through the third space. This doubled thickness of nervous tissue explains the frequent appearance of neuromas in the third space. Whoever designed the foot certainly made a mistake by not thinking about the extra mass of nerve tissue in this area.

Most often, forefoot neuroma is located in the third space, that is, between the third and fourth toes (see Fig. 4.1). This was first noted by Dr. Dudley Morton, a pioneer in foot research. Hence the name – “Morton’s neuroma”. Less common, in descending order, are neuromas of the second, first and fourth spaces.

Symptoms of neuroma are perceived differently by patients and are expressed to varying degrees.

The most common symptom is a burning sensation in the area of ​​the fingers affected by the neuroma. Some patients have the impression of distension and displacement in the space between the fingers. Many people feel pain, sometimes very sharp, cutting. Discomfort inevitably increases when wearing tight shoes or high heels, when additional stress is placed on the forefoot.

One of the tests for diagnosing neuroma is called Mulder's sign, named after the doctor who first used this method. I place my right thumb under the painful space and squeeze the metatarsal heads with my left hand. If the patient has a neuroma, acute pain occurs and immediately a nodule appears above the surface of the skin, and the patient bursts into curses. The larger the nodule, the larger the neuroma. In 85% of cases, this test can distinguish neuroma from pain in the metatarsal heads.

Unfortunately, when it comes to a neuroma, you cannot count on 100% success of treatment. The highest figure in this case is 75%, regardless of the method chosen.

Treatment is determined by the cause of the disease. If the main culprit of the problem was uncomfortable shoes, then first of all you need to get rid of them, and forever. Additionally, if the neuroma is causing severe discomfort, I will inject hydrocortisone with an anesthetic into the area around the inflamed nerve. Improvement occurs in 30% of cases, although in the first days the discomfort may intensify, since the injection itself irritates the nerve.

For most neuromas, the cause can be determined using computer gait analysis. If the problem is in the biomechanics of the foot, orthopedic inlays help in 80% of cases.

If the neuroma does not respond to the above treatment and seriously limits the patient's normal lifestyle, surgery should be considered.

However, I choose this option only if the patient’s quality of life has sharply deteriorated. I use great caution in surgical interventions involving nerves, because they are very complex and do not always give the desired effect. Surgery for a severely inflamed neuroma involves excision of the affected portion of the nerve. It can be done right in your doctor's office under local anesthesia and takes no more than an hour. The patient will be able to walk immediately, and full recovery will occur in 6–8 weeks. During recovery, the discomfort will be completely insignificant compared to the sensations before the neuroma was removed.

The US Navy routinely tests recruits' endurance with a 20-mile cross-country course after a very short training period. To enhance the sadistic effect, the sailors are forced to wear combat boots rather than sneakers. Try running 20 miles in heavy boots unless you're super fit! For 5% of recruits, the cross-country race ends with marching fractures of the metatarsal bones. The second metatarsal bone suffers most (50% of cases), then the third (25%), and another 25% occurs on the fourth metatarsal bone. I have never seen a marching fracture of the first or fifth bones.

A marching fracture is the result of strong and often prolonged pressure on a bone. It often occurs in the metatarsal bones, but it also occurs in other bones of the foot and leg. It's not just Marines who suffer from march fractures. They affect both runners who overload one part of the foot, aerobics enthusiasts who do not know how to stop them, and those who wear high heels, which create additional pressure on the forefoot. A metatarsal march fracture can also occur if there are problems with plantar flexion.

If such a fracture occurs naturally, it will cause pain, but the distribution of weight on the metatarsal heads will become completely normal.

You might think that the fracture is clearly visible on an x-ray, but with a marching fracture this is not the case until 4-6 weeks have passed since the injury. The image usually shows a callus that forms during the healing process, connecting the edges of the broken bone.

But if a march fracture is not visible on an x-ray, how can it be diagnosed? One way is to palpate the base of the metatarsal bone. If pressure on a protruding part of the bone causes pain, it gives you pause. Also, with a fracture, there is swelling of the soft tissue over the damaged bone. In difficult cases, a radioisotope bone scan is performed, for which a radioactive dye is injected into the blood. If the test shows a “hot spot” at the site of the suspected fracture, then the diagnosis is confirmed.

A fracture of the foot bone, whether of marching or traumatic origin, usually heals on its own. Unlike other bones of the body, in case of a march fracture, the metatarsal bones do not require reduction. Therefore, a cast is not needed to immobilize the healing bone in the correct position. Therefore, with such a fracture, the recovery period is easier. However, care must be taken not to overload the damaged bone and to avoid putting excessive pressure on the forefoot. And first of all, it is necessary to exclude the type of activity that caused the stress fracture. This includes running, tennis and similar physical exercises. Women should not wear high heels. Comfortable sneakers are ideal for the three weeks of recovery required.

Ultrasound treatment is not recommended for marching fractures. Ultrasonic waves interfere with the natural healing process of broken bones. Many patients have complained to me about pain resulting from unjustified use of ultrasound treatment. And the problem is not the lack of preparedness of doctors, but the incorrect initial diagnosis.

As I noted above, marching fractures can easily be mistaken for other metatarsal diseases.

And finally, a little common sense. If you have been diagnosed with a marching fracture, you will have to be patient until it heals. If you rush things - start running too early or wear high heels - you will prolong your suffering and delay your recovery by several weeks.

Two sesamoid bones are located under the first metatarsal bone at the joint of the big toe (see Fig. 1.1). These sesame seed-shaped bones do not play a special role in the biomechanics of the foot. According to evolutionary theory, we inherited them from ancestors who spent much more time on four limbs than we did.

Although the sesamoid bones have minimal impact on the biomechanics of the foot - unless they are broken or become an area of ​​inflammation - this is not the case in horses. Fractures of the sesamoid bones are often found in racing horses that push heavily with their hooves when running. If such a fracture occurs, the horse sometimes has to be disposed of. I won’t say that people don’t have problems with similar bones, but the outcome turns out to be much less dramatic.

Unfortunately, the sesamoid bones break and the soft tissue around them becomes inflamed and painful. There are two reasons for this. First, the sesamoid bones are located very close to the surface of the foot. Secondly, in the case of pathological plantar flexion, the first metatarsal bone is in direct contact with the ground. This condition is called forefoot valgus (see Fig. 2.3). Although the deformity itself does not cause discomfort or dysfunction, it places additional pressure on the sesamoid bones and can lead to problems.

Sesamoiditis is an inflammation of the area under the first metatarsal head of the big toe joint.

Its causes may be valgus deformity, “opening” the sesamoid bones; activities that place additional pressure on this area; or injury. For example, if a person with hallux valgus plays tennis, which involves a lot of running with sudden starts and sudden stops and stress on a certain part of the foot, this irritates the sesamoid bones. The same can be said for women with a similar deformity who wear high-heeled shoes. The inflammation may appear just under the sesamoid bone or between it and the overlying metatarsal bone. In the latter case, the cartilage between these two bones is injured, and after a few years it wears out to the point that the bones rub against each other.

How can you tell if you have sesamoiditis? If you feel significant pain when you palpate the area under your thumb joint, you are an excellent candidate for this diagnosis. Discomfort is explained by capsulitis or synovitis of the metatarsophalangeal joint and is aggravated by wearing uncomfortable shoes, in particular high heels. The pain begins gradually and becomes unbearable over time. In some cases, numbness is felt due to the proximity of the corresponding nerve, which in turn becomes inflamed due to sesamoiditis. It is often difficult to determine whether the problem is sesamoiditis or a sesamoid fracture. As a rule, with a fracture, the swelling is more pronounced, and the pain comes suddenly and varies in intensity.

Treatment for sesamoiditis largely depends on its cause. If the problem is a hallux valgus deformity of the forefoot, orthopedic aids can help correct the anomaly. This treatment provides rapid relief without drugs or other therapies. If the disease occurs due to a sports injury, ultrasound or ice are effective, after which the inflammation goes away. If sesamoiditis becomes chronic, as a last resort you can resort to injections of cortisone, which helps well in this case.

A fracture of the sesamoid bone can occur as a result of trauma or overexertion. When a fracture occurs, the patient experiences pain in the corresponding area. The fracture is usually visible on an x-ray, but there may still be problems with diagnosis. In about 20% of people, the sesamoid bone is divided into two parts at birth. This congenital feature does not cause any harm or pain, but on an x-ray it can be mistaken for a bone fracture. Therefore, a radioisotope bone scan may be needed to show whether the sesamoid bone is actually broken. The appearance of a “hot spot” on the monitor will answer the question.

Healing a fracture is not easy. The problem is poor blood supply to this area combined with constant stress from walking and running. After a fracture, the sesamoid bone will forever remain divided in two, but the pain will subside and disappear over time.

If the pain is so noticeable that it affects the patient's quality of life, surgery will have to be considered. The operation involves removing protruding parts of the bone, but it cannot be called extensive. In fact, the operation can be performed under local anesthesia, and the patient will be able to leave the office on his own feet. Healing time depends on the patient's determination to fully recover and not put any weight on the leg until the discomfort with normal activities completely disappears.

I have already talked a lot about foot diseases, but I have hardly mentioned the middle section. To refresh your memory, look again at Fig. 1.1. He will remind you that there are five bones in the middle section: the scaphoid, three wedge-shaped and one cuboid. They connect to the metatarsal bones of the forefoot and the heel bone, so the cuneonavicular joint plays an important role in the biomechanics of the foot.

The sphenodvicular joint is so inactive that deviations from the norm rarely occur there. In addition, the tarsal bones are thick, almost cubic in shape. Therefore, they withstand loads well, with the exception of severe damage. In all my years of practice, I have only once encountered a fracture of the cuboid bone in an athlete who, through carelessness and thoughtlessness, dropped a barbell on his leg.

However, certain deviations in biomechanics create additional stress on the sphenodvicular joint. The result is early wear and mild degeneration, which can later lead to osteoarthritis. But in most cases, the disease is mild, and a person with a worn-out sphenodvicular joint hardly notices any unpleasant symptoms.

The midfoot can be affected by several neuromuscular diseases, resulting in loss of sensation in the midfoot and an inability to control foot movements. They can cause significant degenerative changes in the sphenodvicular joint. But I have seen very few patients with such neuromuscular diseases, so instead of filling your head with stories about them, I’d better say that the chance of getting them is close to zero.

I didn't pay attention to the fifth finger, the little finger. Other than injury or a callus, the only thing that can happen to him is bursitis of the fifth metatarsophalangeal joint.

Bursitis in this joint is similar to bunion in the big toe and is caused by two problems with the biomechanics of the foot. The first of them is congenital, it manifests itself if the angle between the IV and V metatarsal bones is more than 20°. Not everyone with this anomaly will suffer from bursitis, but the chances of it increasing as the angle increases, especially in combination with a second biomechanical problem - plantar flexion, which causes subsidence of the fifth metatarsal bone. As a result of the added pressure on this area due to the fact that the head of the bone never rises, the fifth metatarsal bone literally moves away from the center of the foot in an attempt to distribute the load more evenly.

In response to constant pressure, a “bone” appears over time on the outside of the toe at the head of the fifth metatarsal bone. It is of the same nature as the “bone” on the thumb, but smaller in size.

Due to the congenital nature of the problem, it is very difficult to prevent the development of bunion of the little finger. If it really hurts, surgery is the only option. It consists of two stages: removal of the outer “bone” on the toe and subsequent osteotomy to realign the metatarsal bone. In most cases, the intervention is successful, whether it is performed using an “open” method or using a minimally invasive surgical technique. The metatarsal bone returns to normal after a 4-6 week recovery period.

Another area that often gets overlooked in discussion is the base of the fifth metatarsal. The peroneal muscle is attached to the tubercle of the base of the fifth metatarsal bone, and with a strong everting tension of the foot, a fracture-crack (avulsion fracture) of the tubercle of the bone or a complete separation of the tendon with its fragment can form. It occurs when a large force is applied and often goes undetected on x-ray when an ankle fracture or similar injury is suspected.

This fracture is difficult to diagnose because the talus is located very close to the base of the fifth metatarsal and swelling in this area can easily be mistaken for an ankle injury. To avoid mistakes, the doctor has to be very careful. If x-rays confirm a fracture of the base of the fifth metatarsal, treatment is almost the same as for a marching fracture of any other metatarsal. Within a few weeks, the fracture heals on its own, without plaster or additional impact. But the patient must be careful not to put any weight on the injured leg.

On the plantar side of the metatarsophalangeal joint of the first toe, in the structure of the flexor apparatus there are two small bones smaller than a pea. Despite the fact that the bones are very small in size, they play a huge role during walking, running, jumping and other stress on the foot. If the sesamoid bones are involved in any pathological process, they become a source of severe pain, significantly worsening the patient’s quality of life.

Anatomy

At the base of the first toe is the first metatarsophalangeal joint, which is important from a functional point of view. Two small sesamoid bones are located on the plantar side of this joint: one is located on the inside, the other on the outside. The sesamoid bones are located inside the flexor tendons of the first finger. These structures together form the flexor apparatus of the first toe. Since the first finger bears heavy loads, these loads are performed due to the flexion apparatus. Sesamoid bones increase the leverage of the flexor tendons on the phalanges of the first finger, and also reduce the force of friction between the tendons and soft tissues in the position of extension of the first finger.

Causes

Pain syndrome can develop for various reasons. One of the reasons is overload of the ligamentous apparatus of the sesamoid bones. This condition may be called sesamoiditis. Overload most often develops after excessive running or dancing.

Another cause of pain associated with the sesamoid bones is fractures. Fractures can occur when landing directly on the first metatarsophalangeal joint of the foot. So-called stress fractures of the sesamoid bones may also occur. Stress fractures occur due to constant exposure to large loads on the sesamoid bone apparatus. This is typical for athletes; athletes are most often affected.

Another reason is arthrosis of the joint between the head of the first metatarsal bone and the sesamoid bones. When the big toe moves, the sesamoid bones slide anteriorly and posteriorly along the plantar surface of the head of the first metatarsal bone. Like other joints in the body, this joint can develop arthrosis. Arthrosis in this joint is typical for patients with a high longitudinal arch of the foot. With a high longitudinal arch of the foot, the apparatus of the sesamoid bones is under greater tension and the joints of the sesamoid bones are subject to greater load. Eventually, the cartilage of the sesamoids and the head of the first metatarsal begins to deteriorate.

A rare cause is a disruption of the blood supply to the sesamoid bones, resulting in disruption of the bone structure. This condition is called avascular necrosis of the sesamoid bone. In this case, calcium deposits may additionally form in the soft tissues around the first metatarsophalangeal joint.

Sometimes pain from the plantar surface comes from additional soft tissue formations under the big toe. For example, plantar keratosis can cause pain on the plantar aspect of the first metatarsophalangeal joint.

Symptoms

Patients with pathology of the sesamoid bones usually feel aching pain from the plantar surface of the metatarsophalangeal joint of the first toe. When touched from the plantar side, the pain intensifies. Movement in the thumb joint is often limited. Patients notice that when walking, the pain intensifies before the foot pushes off for the next step. From time to time, the first metatarsophalangeal joint may become stuck or click, which increases pain. After rest, the pain goes away or weakens. Some patients report numbness in the area of ​​the first and second toes.

Diagnosis

The doctor will ask many questions about the development of the disease. You will be asked about your current complaints and past foot problems. The doctor will examine your feet. The examination may be a little painful, but it is necessary to identify painful points and check the movements of the fingers. The patient may be asked to walk around the room.

It is mandatory to take an x-ray (x-ray). Several projections are performed. One of them is the axial one, on which the sesamoid bones are clearly visible. This projection requires special placement and the X-ray beam comes at an angle.

An x-ray may reveal that the sesamoid bone is composed of two or more separate bones, as if it were a fracture, but the boundaries between them are smooth. This is normal and can occur in every tenth person. The x-ray evaluates the position of the sesamoid bones, as well as the space (articulation) between the metatarsal head and the sesamoid bones. The joint space normally appears uniform on x-ray. Narrowing and unevenness indicate pathology.

If it is difficult to judge the presence of a sesamoid fracture from a plain X-ray, a scan may be ordered. This is a test in which a special solution, a contrast agent, is injected intravenously. The contrast agent accumulates in the bone tissue in a certain way. By scanning the human skeleton with X-rays, special images are created that reflect the accumulated X-ray contrast agent. If there is a pathological focus in the bone tissue, then the pattern of accumulation of the contrast agent will look different. Each pathological process has its own unique pattern of contrast agent accumulation. In this way, a fracture can be distinguished from a congenital separation of the sesamoid bone.

To obtain the most complete picture of the disease, magnetic resonance imaging (MRI) may be necessary. Using MR images, you can study the relationships between the anatomical structures of the foot and exclude other pathological processes, including infection.

Treatment

Conservative treatment
As a rule, treatment begins with conservative methods. Typically, in this case, nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, indomethacin, and ibuprofen, are recommended. These remedies usually relieve pain and inflammation well. You can try using special insoles that ease the load on the first metatarsophalangeal joint. Be sure to avoid using high-heeled shoes. The higher the heel, the greater the load on the forefoot, and therefore on the painful metatarsophalangeal joint. In some cases, your doctor may suggest injecting a steroid into the painful area. This usually helps relieve severe pain.

If there is a sesamoid fracture without a rupture of the extensor apparatus, wearing a plaster or plastic splint for approximately six weeks is recommended. After this, the patient must wear hard-soled shoes. The rigid sole holds the toe in a straight position, preventing the foot from rolling - thus relieving the load on the flexion apparatus. In some cases, the doctor may recommend treatment without the use of splints, prescribing the wearing of shoes with hard soles. If a fracture of the sesamoid bone occurs with a rupture of the flexor apparatus, then surgical treatment is necessary to fully restore function.

Stress fractures and aseptic necrosis of the sesamoid bone are less responsive to conservative treatment. Some doctors recommend a plaster or plastic splint for up to eight weeks without putting any weight on the leg. If, after prescribing conservative treatment, it does not get better within 8 to 12 weeks, then surgery is most likely necessary.

Surgical treatment

Sesamoid bone removal
Your doctor may suggest removing part or all of the sesamoid bone. When the sesamoid bone is partially removed, the other sesamoid bone is able to provide a fulcrum for the flexors. However, if both bones are removed, the flexors will not be able to function normally and the first toe will become claw-shaped. Therefore, surgeons usually avoid removing both sesamoid bones.

When the sesamoid bone is fractured, surgery is performed to remove non-functional fragments and restore the integrity of the flexor apparatus. For stress fractures in athletes, when the most complete recovery is needed, surgery can be performed using bone grafts. To remove the sesamoid bones, an incision is made on the inside of the foot. Sometimes it becomes necessary to perform this operation from an incision along the plantar side of the foot between the heads of the first and second metatarsal bones.

Rehabilitation

Rehabilitation after conservative treatment
If the pain syndrome is mild, the doctor may allow you to continue your daily activities immediately, but with the condition that you use shoes with hard soles. If the disease is moderate, you will need to use crutches and not put any weight on your leg for a period of several days to two to three weeks. If the pain is severe, you will need to walk on crutches without putting any weight on your leg for several weeks. Typically, full recovery should not be expected until four to six weeks.

Physical therapy can help reduce pain and swelling. If there are no contraindications, then ultrasound and thermal procedures are prescribed. Sometimes the use of anti-inflammatory ointments and creams is combined with physiotherapy.

Rehabilitation after surgical treatment
After surgery, most patients are advised to use crutches and avoid putting weight on the leg. For those who have undergone restoration of the flexor apparatus of the first toe or bone grafting, immobilization with a plaster or plastic splint is recommended. After this, it is recommended to wear shoes with hard soles until complete recovery. The results of bone grafting of the sesamoid bone can be assessed after 2 months by performing an MRI.

Physical therapy exercises are required. Depending on the operation performed, exercises begin at different times after the operation, gradually increasing the load and complexity. Therapeutic exercise is necessary to restore and maintain muscle tone of the lower leg and foot.

The most complete answers to questions on the topic: “sesamoid bone of the knee joint treatment.”

Sesamoiditis is one of the most common diseases of dancers and athletes. The essence of the pathology is that in the sesamoid bones, which are located inside the tendons, for one reason or another, an inflammatory process begins to develop.

Most often, this disease affects the sesamoid bones of the first toe, because when walking, dancing, playing sports, especially running, a person relies on them. Therefore, strong and constant physical activity can lead to injury. Despite the fact that the size of these bones does not exceed the size of a pea, they play a huge role in the comfortable walking of a person.

Causes

Sesamoiditis of the first toe most often occurs in young people, especially if they prefer to play sports or dance. Therefore, the main cause of the disease can be considered excessive physical stress on the legs without proper rest and alternation of rest modes and sports or dancing.

However, pathology cannot appear overnight. To do this, a certain amount of time must pass and certain conditions must coincide. And the main one is the thinning of the subcutaneous fat layer on the sole of the foot. As soon as this happens, the disease itself gradually begins to develop due to the fact that the sesamoid bones bear an additional heavy load.

However, inflammation is only one half of the problem. If you continue to neglect your health, a fracture of these bones may occur, which almost never heals, and in order to return the legs to their former ease when walking, surgical intervention is necessary.

Sesamoiditis often coexists with another disease - foot valgus deformity of the first toe. This is especially true for women. Therefore, if you have this diagnosis, it is necessary to more carefully monitor the health of your legs and try to get rid of this problem so as not to get inflammation of the sesamoid bones.

More articles: Complex for joints

Symptoms

The main symptom of sesamoiditis is pain. Moreover, at the very beginning it is insignificant and few people pay attention to it. However, over time it intensifies and becomes almost unbearable.

The pain intensifies when wearing high-heeled shoes or tight and uncomfortable shoes. However, it is worth remembering that inflammation of these bones and their fracture have similar symptoms. True, with a fracture, more pronounced swelling occurs, and pain occurs suddenly during dancing or playing sports. Moreover, at this moment a person can even be wearing shoes without heels.

In some cases, patients may notice numbness of the first toe. This is very simple to explain. This phenomenon occurs when a nerve is involved in the pathological process. It begins to become inflamed because it is close to the bone itself.

Diagnostics

Diagnosis of the disease, as a rule, does not have any problems. This is done by examining the first toe and interviewing the patient. Sometimes x-rays or MRIs are performed.

If there is doubt about the diagnosis, a joint puncture is performed. This is necessary in order to distinguish inflammation of the sesamoid bones from pathologies such as gout or arthritis, which have almost the same symptoms.

Conservative treatment

Treatment of sesamoiditis is carried out at home and depends only on what caused the inflammation. If the inflammation appears due to hallux valgus, then wearing individually selected orthopedic shoes helps correct the abnormal position of the first toe, and such treatment quickly leads to recovery without the use of medications.

If the cause is a sports injury, then the treatment is to apply ice to the site of inflammation or use ultrasound. In this case, the legs need rest and a certain period of time without sports training. Thanks to such simple treatment, the pathology also goes away on its own. But in the future you need to treat your feet more carefully.

More articles: How to relieve joint inflammation with arthrosis with medication?

If the disease has reached a chronic stage, then a cortisol injection, which is given directly into the inflamed joint, helps a lot. However, such injections can only be performed in a hospital setting.

As for the fracture, it is also clearly visible on an x-ray or MRI, however, in 20% of the entire population of the planet, the sesamoid bone is divided into two halves, so this feature is often considered a fracture. This means that only an experienced specialist should diagnose the disease.

Current version of the page so far

not checked

Current version of the page so far

not checked

experienced participants and may differ significantly from

Sesamoid bones(from Latin Sesamum) - bones located in the thickness of tendons and usually lying on the surface of other bones. Sesamoids are noted in areas where tendons pass over joints (eg, wrist, knee, foot). The sesamoid bones provide protection to the tendons and keep the tendons some distance from the center of the joint, increasing the leverage of force.

The sesamoid bones are closely connected to the joint capsule and muscle tendons. One of their surfaces is covered with hyaline cartilage and faces the joint cavity.

In human anatomy

Sesamoid bones can be located in any joint area, including:

• knee joint - patella (in the thickness of the quadriceps tendon)
• hand - two sesamoid bones are located in the distal parts of the first metacarpal bone. There is usually also a sesamoid bone in the distal portion of the second metacarpal. The pisiform bone of the wrist is also, in fact, a sesamoid, located in the tendon of the flexor carpi ulnaris.
• foot - two sesamoid bones in the area where the first metatarsal bone joins the first toe (inside the tendon of the flexor hallucis brevis).

More articles: Knock in a child's knee

Diseases of the sesamoid bones

A common foot disease among dancers is sesamoiditis. There are also bifurcated sesamoid bones, which can be either congenital or post-traumatic.

If there is insufficient blood supply to the joint in which the sesamoid bone is located, it can also lead to tissue necrosis.

In addition, arthrosis of the joint is possible, most often observed in people with a high longitudinal arch of the foot. The consequence of this disease is the complete destruction of the articular cartilage and sesamoid cartilage.

Notes

1. Tim D. White Human Osteology, 2nd edition (San Diego: Academic Press, 2000), 199, 205.
2. White, Human Osteology, 2nd edition, 257-261.

Wed, 08/24/2016 – 02:09

Not on the site

Last visit: 2 years 3 weeks ago

Registered: 08/24/2016 – 01:40

Publications: 1

Hello.
Male, 31 years old, 185 cm, 85 kg. The lifestyle for the last 5 years has been sedentary. I do not smoke.
My left knee has been bothering me for half a year, it started hurting on the first day of a cold in February, and there is severe, tolerable pain when walking up the stairs. If you accidentally hit something with your left patella, it hurts; on the right, under the same conditions, it doesn’t hurt; when you palpate the left knee in a bent position on the front side, it hurts from the patella and below. The picture shows no bone changes, ultrasound of the joints showed Becker cysts in the left joint. Rheumatoid factor, c-reactive protein, antistreptolysin O - all negative.

The diagnosis from a rheumatologist in May was prearthrosis of the left knee joint.

I took Nise 2x100 for 14 days, Diaflex for 3 months.

The orthopedist-traumatologist diagnosed in June - periarthritis, suggested - Hi-Flex injections. Didn't give injections.
As a result, today on the left side there is pain when walking up the stairs, pain while standing, pain is tolerable when sitting.

Associated diseases - superficial gastritis, reflux esophagitis, heart problems (post-myocardial cardiosclerosis, ventricular extrasystole EI - 2.7%), trigeminal neuralgia. There were no problems with bones and joints before.