title: Effect of various hallux valgus reconstruction on sesamoid location: a radiographic study.
abstract: BACKGROUND
  The correction of sesamoid subluxation is an important component of hallux valgus reconstruction with some surgeons feeling that the sesamoids can be pulled back under the first metatarsal head when imbricating the medial capsule during surgery. The purpose of this study was to radiographically assess the effect of an osteotomy on sesamoid location relative to the second metatarsal.
  
  
  METHODS
  This is a retrospective radiographic study review of 165 patients with hallux valgus treated with reconstructive osteotomies. Patients were included if they underwent a scarf or basilar osteotomy for hallux valgus but were excluded if they had inflammatory arthropathy or lesser metatarsal osteotomy. A modified McBride soft tissue procedure was performed in conjunction with the basilar and scarf osteotomies. Each patient's preoperative and postoperative radiographs were evaluated for hallux valgus angle, intermetatarsal 1-2 angle, tibial sesamoid classification, and lateral sesamoid location relative to the second metatarsal.
  
  
  RESULTS
  The greatest correction of both hallux valgus and intermetatrsal 1-2 angle was achieved in basilar osteotomies (20.6 degrees and 9.7 degrees, respectively), then scarf osteotomies (14.4 degrees and 8.7 degrees, respectively). Basilar and scarf osteotomies both corrected medial sesamoid subluxation relative to the first metatarsal head an average of 2-3 classification stages. All osteotomies had minimal lateral sesamoid location change relative to the second metatarsal.
  
  
  CONCLUSIONS
  The majority of sesamoid correction correlated with the intermetatarsal 1-2 correction. The concept that medial capsular plication pulls the sesamoids beneath the first metatarsal (ie, changes the location of the sesamoids relative to the second metatarsal) was not supported by our results.
  
  
  METHODS
  Level III, retrospective case series.
authors: Department of Orthopedics, University of Southern California, Los Angeles, California, USA.
authors: Eddie H
authors: EH
authors: Huang
authors: Timothy P
authors: TP
authors: Charlton
authors: Samuel
authors: S
authors: Ajayi
authors: David B
authors: DB
authors: Thordarson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011184:Postoperative Period; D057234:Preoperative Period; D011859:Radiography; D012189:Retrospective Studies; D012716:Sesamoid Bones / Q000000981:diagnostic imaging*; D055815:Young Adult