ABSTRACT

 Background: Research on the surgical treatment of stress fractures and AVN of the sesamoid bone is the goal of this paper. Material and Methods: A group of twenty individuals who exhibited clinical indications of avascular necrosis of the sesamoids had a dynamic assessment of blood circulation using a high-resolution gamma chamber equipped with a rectangular double detector. The purpose of doing this test was to ascertain the presence or absence of the ailment among the patients. The examination was conducted with both frontal and lateral projections of the patient's area of interest. Results: The age range of the patients included in the study spanned from 18 to 51 years, with a mean age of 30.52±3.69 years. The sample consisted of 20 patients, of which 16 (80%) were female and 4 (20%) were male. Out of the total sample size of 20 patients, it was observed that 8 individuals, constituting 40% of the participants, presented with a pathological state in their right foot. Conversely, 12 patients, accounting for 60% of the cohort, exhibited a pathological condition in their left foot. Each individual displayed the sensation of discomfort in the affected forefoot, and further examination revealed that three individuals, constituting 15% of the sample, also presented with localised edoema and rubor. Out of the sample population, 12 patients (representing 60% of the sample) exhibited undivided sesamoids, whereas 6 patients (representing 30% of the sample) had bipartite tibial sesamoids. Additionally, 2 patients (representing 10% of the sample) demonstrated bipartition of both the tibial and fibular sesamoids.  In a sample of patients, it was observed that the tibial sesamoid was affected in 11 individuals, accounting for 55% of the cases, while the fibular sesamoid was influenced in 9 people, representing 45% of the cases. It was determined that each patient was donning footwear that was ill-suited for their individual foot structure, and/or the patients self-reported experiencing traumatic incidents, with or without accompanying fractures. Out of the total patient population, five individuals were engaged in dancing activities, while one patient participated in football. Out of the total number of female patients observed, specifically two individuals or fifty percent, were found to be utilising any form of contraceptive method. Twelve patients, about 60% of the total, did not experience any relief of symptoms. In these cases, surgical excision of the necrotized sesamoid tissue was necessary. Three individuals experienced the emergence of discomfort, edoema, and localised paresthesia, ultimately resulting in a minor degree of claudication. Conclusions: The current body of research lends credence to the idea that early non-surgical care of instances with avascular necrosis of the sesamoid should be pursued. The recommended treatment regimen would encompass the utilisation of anti-inflammatory pharmaceuticals, the utilisation of suitable footwear, and the avoidance of activities that involve bearing weight.