Original Research| Volume 56, ISSUE 5, P1041-1046, September 2017

Comparison of Tibial Sesamoid Position on Anteroposterior and Axial Radiographs Before and After Triplane Tarsal Metatarsal Joint Arthrodesis

  • Paul Dayton
    Address correspondence to: Paul Dayton, DPM, MS, FACFAS, College of Podiatric Medicine and Surgery, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312.
    Director, Podiatric Medicine and Surgery Residency, UnityPoint Clinic, Trinity Regional Medical Center, Fort Dodge, IA

    Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA
    Search for articles by this author
  • Mindi Feilmeier
    Assistant Professor, College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, IA
    Search for articles by this author


      We reviewed the radiographic results of a group of patients who had undergone triplane correctional tarsometatarsal arthrodesis for symptomatic hallux abducto valgus with metatarsus primus abducto valgus. Of the 21 feet included in the present review, 17 (81%) displayed radiographic findings of metatarsal pronation preoperatively based on axial sesamoid views and positive lateral round sign on anteroposterior radiographs. At a mean follow-up period of 5.2 ± 1.6 months, a significant improvement in the tibial sesamoid position (TSP) on both anteroposterior (AP) and axial radiographs was measured. A negative metatarsal round sign, indicating correction of coronal plane metatarsal rotation, was observed in 20 of the 21 feet (95.2%) on AP radiographic evaluation. All 21 patients (100%) had obtained resolution of sesamoid subluxation on the sesamoid axial view at the final follow-up examination. The sesamoid axial position was consistently normal when the round sign was absent, and the TSP was in the normal range of 1 to 3 on the AP radiograph. Sesamoid subluxation from the normal position with the tibial sesamoid on or lateral to the crista was noted in 4 feet (19%) preoperatively and 0 feet postoperatively. This confirmed that lateral round sign of the first metatarsal head and a high TSP noted on the AP radiograph are both related to metatarsal pronation and can be corrected concurrently with coronal plane varus rotation of the first metatarsal as a part of the procedure.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Martin D.E.
        Preoperative radiographic evaluation in HAV surgery: a critical analysis of PASA and other soft tissue adaptation.
        in: Camasta C.A. Vickers N.S. Ruch J.A. Reconstructive Surgery of the Foot and Leg. Podiatry Institute, Tucker, GA1993
        • Chi T.D.
        • Davitt J.
        • Younger A.
        • Holt S.
        • Sangeorzan B.J.
        Intra- and inter-observer reliability of the distal metatarsal articular angle in adult hallux valgus.
        Foot Ankle Int. 2002; 23: 722-726
        • Dayton P.
        • Merrell K.
        • Feilmeier M.
        Is our current paradigm for evaluation and management of the bunion deformity flawed? A discussion of procedure philosophy relative to anatomy.
        J Foot Ankle Surg. 2015; 54: 102-111
        • Dayton P.
        • Feilmeier M.
        • Hirschi J.
        • Kauwe M.
        • Kauwe J.S.
        Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model.
        J Foot Ankle Surg. 2014; 53: 274-278
        • Dayton P.
        • Feilmeier M.
        • Kauwe M.
        • Hirschi J.
        Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsal metatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature.
        J Foot Ankle Surg. 2013; 52: 348-354
        • Boberg J.S.
        • Judge M.S.
        Follow-up of the isolated medial approach to hallux abducto valgus correction without interspace release.
        J Am Podiatry Med Assoc. 2002; 92: 555-562
        • Talbot K.D.
        • Saltzman C.L.
        Assessing sesamoid subluxation: how good is the AP radiograph?.
        Foot Ankle Int. 1998; 19: 547-554
        • Catanese D.
        • Popowitz D.
        • Gladstein A.
        Measuring sesamoid position in hallux valgus, when is the sesamoid axial view necessary.
        Foot Ankle Spec. 2014; 7: 457-459
        • Okuda R.
        • Yasuda T.
        • Jotoku T.
        • Shima H.
        Proximal abduction-supination osteotomy of the first metatarsal for adolescent hallux valgus: a preliminary report.
        J Orthop Sci. 2013; 18: 419-425
        • Chen J.
        • Rikhrai K.
        • Gatot C.
        • Lee J.Y.
        • Singh Rikhrai I.
        Tibial sesamoid position influence on functional outcome and satisfaction after hallux valgus surgery.
        Foot Ankle Int. 2016; 37: 1178-1182
        • Okuda R.
        • Kinoshita M.
        • Toshito Y.
        • Jotoku T.
        • Kitano N.
        • Shima H.
        The shape of the lateral edge of the first metatarsal head as a risk factor for recurrence of hallux valgus.
        J Bone Joint Surg. 2007; 89: 2163-2172
        • Hardy R.
        • Clapham J.
        Observations on hallux valgus; based on a controlled series.
        J Bone Joint Surg Br. 1951; 33B: 376-391
        • Kim Y.
        • Kim J.S.
        • Young K.W.
        • Naraghi R.
        • Cho H.K.
        • Lee S.Y.
        A new measure of the tibial sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal in CT scans.
        Foot Ankle Int. 2015; 36: 944-952
        • Mizuno S.
        • Sima Y.
        • Yamaxaki K.
        Detorsion osteotomy of the first metatarsal bone in hallux valgus.
        J Jpn Orthop Assoc. 1956; 30: 813-819
        • Dayton P.
        • Kauwe M.
        • Feilmeier M.
        Clarification of the anatomic definition of the bunion deformity.
        J Foot Ankle Surg. 2014; 53: 160-163
        • Scranton P.E.
        • Rutkowski R.
        Anatomic variations in the first ray—part 1: anatomic aspects related to bunion surgery.
        Clin Orthop Relat Res. 1980; 151: 244-255
        • Mortier J.P.
        • Bernard J.L.
        • Maestro M.
        Axial rotation of the first metatarsal head in a normal population and hallux valgus patients.
        Orthop Traumatol Surg Res. 2012; 98: 677-683
        • Grode S.E.
        • McCarthy D.J.
        The anatomic implications of hallux abducto valgus: a cryomicrotomic study.
        J Am Podiatry Med Assoc. 1980; 70: 539-551
        • DiDomenico L.A.
        • Fahim R.
        • Rollandini J.
        • Thomas Z.M.
        Correction of frontal plane rotation of sesamoid apparatus during Lapidus procedure: a novel approach.
        J Foot Ankle Surg. 2014; 53: 248-251