Avaskuläre Nekrosen der Sesambeine

Avascular necrosis of the sesamoids is a rare differential diagnosis for plantar pain of the first metatarsal head. A prevalence of 1% is assumed. The exact etiolog is not known, but it correlates with increased forefoot loading in athletes or in pes cavus. MRI allows early diagnosis, whereas specific pathologic changes with consolidation and fragmentation are visible in radiography only after 6 to 12 month and have to be differentiated from fractures and bipartide sesamoides. Treatment is primarily conservative comprising off-loading of the forefoot, immobilization in a walker and the use of NSAIDs. Infiltrations with PRP and shockwave therapy have also shown promising results in individual cases. If symptoms persist, sesamoidectomy has shown satisfactory results. Complications such as postoperative hallux valgus or hallux varus seldom occur, but have to be considered.