The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis

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Aper, Rhonda L.¹; Saltzman, Charles L.¹; Brown, Thomas D.¹

The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis

Foot Ankle Int. September 1994;15(9):462-470

Affiliations

¹Departments of Orthopaedic Surgery and Biomedical Engineering, The University of Iowa, Iowa City, Iowa 52242
Abstract

In this cadaver study, the functional significance of the hallux sesamoid bones was quantified by measuring the effective tendon moment arm (ETMA) of the flexor hallucis brevis (FHB) force. (The ETMA differs from the anatomic tendon moment arm in that ETMAs are determined by the experimentally measured moment of the tendon force, rather than by the actual location and orientation of the tendon pull in the joint.) The intact case was compared with three levels of progressive sesamoid resection: distal half of the medial sesamoid excised, entire medial sesamoid excised, and both the medial and lateral sesamoids excised. Five dorsiflexion angles of the metatarsophalangeal joint were tested, ranging from −10° to 50°. A known active load was applied to the FHB muscle of fresh frozen cadaver specimens while the corresponding resisting forces from three orthogonally mounted transducers were being recorded. Results showed that the ETMAs decreased significantly (P < .05) only with the excision of both sesamoids. The percent decrease in ETMA was smallest at dorsiflexion angles of −10° and 15° (4.3% and 2.4%, respectively) and largest at dorsiflexion angles of 25°, 35°, and 50° (29.2%, 22.4%, and 26.7%, respectively). The clinical significance of the results is that distal hemiresection of the medial sesamoid or full medial sesamoid excision is unlikely to appreciably compromise the effective mechanical advantage of the FHB muscle. However, this mechanical advantage may be profoundly diminished by excision of both hallux sesamoids.
Links

DOI: 10.1177/107110079401500902

PubMed: 7820237

WoS: A1994PG78200002

Cited Works (12)

Year	Entry
1988	McBryde AM Jr, Anderson RB. Sesamoid foot problems in the athlete. Clin Sports Med. 1988;7(1):51-60.
1985	Silver RL, de la Garza J, Rang M. The myth of muscle balance: a study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg. 1985;67B(3):432-437.
1986	Shereff MJ, Bejjani FJ, Kummer FJ. Kinematics of the first metatarsophalangeal joint. J Bone Joint Surg. 1986;68A(3):392-398.
1979	Stokes IAF, Hutton WC, Stott JRR. Forces acting on the metatarsals during normal walking. J Anat. 1979;129(pt 3):579-590.
1987	Richardson EG. Injuries to the hallucal sesamoids in the athlete. Foot Ankle. 1987;7(4):229-244.
1964	Mann R, Inman VT. Phasic activity of intrinsic muscles of the foot. J Bone Joint Surg. April 1964;46A(3):469-481.
1982	Van Hal ME, Keene JS, Lange TA, Clancy WG Jr. Stress fractures of the great toe sesamoids. Am J Sports Med. 1982;10(2):122-128.
1951	Hardy RH, Clapham JCR. Observations on hallux valgus: based on a controlled series. J Bone Joint Surg. 1951;33B(3):376-391.
1981	Helal B. The great toe sesamoid bones: the lus or lost souls of Ushaia. Clin Orthop Relat Res. 1981;157:82-87.
1993	Rodeo SA, Warren RF, O'Brien SJ, Pavlov H, Barnes R, Hanks GA. Diastasis of bipartite sesamoids of the first metatarsophalangeal joint. Foot Ankle. 1993;14(8):425-434.
1990	Yamaguchi GT, Sawa AGU, Moran DW, Fessler MJ, Winters JM. A survey of human musculotendon actuator parameters. In: Winters JM, Woo SL-Y, eds. Multiple Muscle Systems: Biomechanics and Movement Organization. New York, NY: Springer-Verlag; 1990:717-773.
1965	Sutro CJ, Davis GJ. The big toe: comparative anatomic and radiographic study of the metatarso-phalangeal articulation. Bull Hosp Joint Dis. October 1965;26(2):141-174.

Cited By (12)

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2015	Schein AJ, Skalski MR, Patel DB, White EA, Lundquist R, Gottsegen CJ, Forrester DM, Matcuk GR Jr. Turf toe and sesamoiditis: what the radiologist needs to know. Clin Imgaging. May–June 2015;39(3):380-389.
2016	Melton W, Jackson JB III. Stress fractures of the foot and ankle. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:61-169.
1996	Aper RL, Saltzman CL, Brown TD. The effect of hallux sesamoid excision on the flexor hallucis longus moment arm. Clin Orthop Relat Res. April 1996;325:209-217.
2012	Frimenko RE, Lievers WB, Coughlin MJ, Anderson RB, Crandall JR, Kent RW. Etiology and biomechanics of first metatarsophalangeal joint sprains (turf toe) in athletes. Crit Rev Biomed Eng. 2012;40(1):43-61.
2023	Gupta A, Singh PK, Xu AL, Bronheim RS, McDaniel CM, Aiyer AA. Turf toe injuries in the athlete: an updated review of treatment options, rehabilitation protocols, and return-to-play outcomes. Curr Rev Musculoskel Med. November 2023;16(11):563-574.
2000	Watson TS, Anderson RB, Davis WH. Periarticular injuries to the hallux metatarsophalangeal joint in athletes. Foot and Ankle Clinics. 2000;5(3):687-713.
2009	McCormick JJ, Anderson RB. The great toe: failed turf toe, chronic turf toe, and complicated sesamoid injuries. Foot and Ankle Clinics. June 2009;14(2):135-150.
2010	Hunt KJ, McCormick JJ, Anderson RB. Management of forefoot injuries in the athlete. Operative Tech Sports Med. March 2010;18(1):34-45.
1999	Glasoe WM, Yack HJ, Saltzman CL. Anatomy and biomechanics of the first ray. Phys Therap. 1999;79(9):854-859.
2021	Mettler JH. Strain Estimations of the Plantar Fascia and Other Ligaments of the Foot: Implications for Plantar Fasciitis [PhD thesis]. Iowa State University; 2021.
1999	Anderson FC III. A Dynamic Optimization Solution for a Complete Cycle of Normal Gait [PhD thesis]. University of Texas at Austin; December 1999.