Two Cases of Typical Osteochondropathy of the Medial Sesamoid Bone of the First Metatarsal

THE FIRST1 mi able to report here t w o cases of nu osteochoridropnthy of' the niedinl sesamoicl bone of the great toe, and, a s far as I know, this c2ondition has never been tlescrilwd hefore.Rolf S., age 1.3.W i ~s admitted to the hospital April ?4? 1924.Except for the measles he has had n o infantile diseases.N o glandular complaint as a child.Was quite well until a year ago when, without any known cause, pain developed in both feet, I)eing localized to t h e medial half of t h e anterior arches.T h e pain which only came on when the patirnt was or otherwise standing on his legs soon subsided after a few days of rest.He was then free from symptoms nntil a fortnight before his admission to the hospital, when tht. same complaint re-appeared in his left foot.S o trauma was known t o have ocvurrecl hefore either of these periods of pain.T h e patieut was liniping very innch when adinittetl to the hospital and for pain he could not step on the fore part of his left foot.'There was no spontaneous pain.Objectively, the medial sesnmoid bone underneath the head of the first metatarsal could hr felt to be distinctly tender.I n other respects there was nothing abnorrtii11.Roentgen examination of t h r left foot (Figs. 1 and 2 ) : The medial sesainoid bone underneath t h e head of the first metatarsal is seen to be defnrmed, considerably flattened in the dorso-plantar direction and also slightly from side to side as compared with the lateral sesanioid bone which presented a normal appearance and an eye11 oval shape.The dorsal surface of t h e medial sesamoid bone is concave, the concavity corresponding to t h e convexity of the plantar surface of t h r head of the first metatarsal; its plantar surface is convex.The outlines of the bone are notched in fine waves and uneven.The normal bony structure is replaced b y spots of increased density.In the dorso-plantar roentgenogram t h e bone seems, as it were, t o he divided into three nnequal fragments.CIW 1.