The authors presented a case of Bipartite lesser metatarsal sesamoids — more specifically, one at the fifth metatarsal.
A 31-year-old woman presented to the senior author’s office for evaluation of her right foot after a motor vehicle accident seven days prior.
The patient was previously evaluated at a local emergency department and, although diagnosed with a foot fracture (the patient was unable to state what the fractured bone was), all of her pain was in the ankle.
Pain was not elicited on palpation of the fifth metatarsal head plantarly or on fifth metatarsophalangeal joint active and passive range of motion.
The original radiograph revealed a bipartite sesamoid of the fifth metatarsal.
Contralateral films were taken and were negative for any lesser metatarsal sesamoid.
All pathology was localised to the ankle (marrow contusion to cuboid, navicular, and talus, and partial anterior talofibular ligament and calcaneofibular ligament tearing).
Because of the propensity of misdiagnosis, history and clinical examination are important for obtaining the correct diagnosis.
Examination may demonstrate tenderness, edema, and erythema, and differentiation from fracture by means of radiographic evaluation may be difficult, as a bipartite sesamoid can mimic a fracture.
This case demonstrated radiographic findings of a diagnosed fracture by the radiologist, whereas on physical examination, this region was not painful for the patient.
Since physical examination is not conducted by the radiologist, the authors are of the opinion that the radiologist should be given as much information as possible to help them hone in on the correct diagnosis.
Additional studies may be of benefit in further evaluation for diagnostic accuracy, such as magnetic resonance imaging, computed tomography, or bone scan.
Based on the findings, the authors suggest that bilateral radiographs should be used to evaluate accessory bones or sesamoids, as the incidence of bilateral bipartite hallucal sesamoids is high.
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