Posttraumatic proximal migration of the first metatarsophalangeal joint sesamoids: a report of four cases.

Four cases are presented with plantar plate injury to the first metatarsophalangeal (MTP) joint and proximal retraction of the sesamoids by the flexor hallucis brevis. No history of dislocation occurred in any patient, although two had associated fractures of a sesamoid bone. Clinical and radiographic aids to the diagnosis are discussed. Clinical findings included diffuse pain beneath the first MTP joint and pain with extremes of joint motion in all patients. The anterior-posterior (AP) radiographic technique was the most helpful in determining the proximal migration of the sesamoids. By taking the AP view with both feet on the cassette and by centering the beam perpendicular to it, the diagnosis of plantar plate disruption can easily be made. Initial treatment of this disorder was nonoperative using a stiff soled shoe. With conservative treatment, two of the patients returned to preinjury activities. One patient required sesamoidectomy for resistant pain, and the final patient is still unable to return to his preinjury job requiring standing and heavy lifting.