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Sesamoid Excision
Distinguishing a traumatic sesamoid injury from a bipartite sesamoid can be challenging. Bipartite sesamoids have been reported to exist in 6% to 8% of the population; of these occurrences, 90% are bilateral and 80% are bipartite tibial (medial) sesamoids. Congenitally divided sesamoids have been shown to fracture with less force than normal sesamoids. The differential diagnosis of a painful sesamoid should also include osteonecrosis, nonunion, metatarsalsesamoid arthritis (or chondromalacia), and osteomyelitis of the sesamoid with or without an underlying ulcer. Sesamoiditis, acute or chronic, is frequently the diagnosis in cases in which pain is localized to the sesamoid but no obvious pathology or abnormality is shown on imaging.