The hallucal sesamoid ligament is the fibrocartilaginous connection between the two sesamoid bones of the great toe, maintaining their anatomical relationship within the FHB tendon system.
Maintains the relationship between the medial and lateral sesamoids, allows some relative movement between them, and is disrupted in bipartite sesamoid or sesamoid fracture patterns.
The intersesamoid ligament separates the medial and lateral sesamoids — its disruption in sesamoid fracture or bipartite sesamoid produces separation of the sesamoids on stress views. Bipartite sesamoid (congenital) must be distinguished from acute fracture by smooth rounded edges and bilateral occurrence.
Acute sesamoid fracture disrupting the intersesamoid ligament producing sesamoid separation on stress X-ray, managed by immobilisation or sesamoid excision for non-union.
Congenital bipartite sesamoid with smooth rounded sesamoid edges distinguished from acute fracture on plain X-ray — confirmed by bilateral X-ray and bone scan if uncertain.
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