Presentation
One day of atraumatic right foot pain without any history of infection
Patient Data
Marked fragmentation and plantar displacement of the medial hallux sesamoid.
Case Discussion
The hallux sesamoids are a key component to the weight bearing ergonomics of the foot and can bear upwards of 50% of body weight load. Osteonecrosis of the medial hallux sesamoid (less commonly referred to as Renandier's disease) is an uncommon musculoskeletal manifestation although we were unable to find any data for incidence rates in our literature review. The etiology can be trauma, infection, or idiopathic. The same disease process may occur in the lateral hallux sesamoid (less commonly known as Treves’ disease).
Our patient presented with one day of right foot pain without any history to suggest any acute traumatic or infectious etiology (such as osteomyelitis) of his medial sesamoid fragmentation. The patient was a soccer player and so chronic microtrauma may need to be considered as a potential cause of his osteonecrosis. However in light of no infection history or acute trauma it was deemed likely idiopathic and the diagnosis was ultimately arrived at by means of exclusion.
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