title: The effect of hallux sesamoid resection on the effective moment of the flexor hallucis brevis.
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 degrees to 50 degrees. 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 degrees and 15 degrees (4.3% and 2.4%, respectively) and largest at dorsiflexion angles of 25 degrees, 35 degrees, and 50 degrees (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.
authors: Department of Orthopaedic Surgery, University of Iowa, Iowa City 52242.
authors: R L
authors: RL
authors: Aper
authors: C L
authors: CL
authors: Saltzman
authors: T D
authors: TD
authors: Brown
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D005528:Foot / Q000502:physiology*; D006214:Hallux / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008962:Models, Theoretical; D018485:Muscle Fibers, Skeletal / Q000502:physiology; D013710:Tendons / Q000502:physiology*