Prevalence, morphological variation and ossification of sesamoid bones of the forefoot: a retrospective radiographic study of 8,716 Chinese subjects

Background and Aim: Previous studies provided evidence of a genetic basis for the occurrence of sesamoids bone in the foot among different ethnic populations. However, information for the Chinese population has not been previously reported. Therefore, the aim of our study was to determine the distribution, morphological variation and ossification timeline of sesamoid bones of the forefoot in a large sample of the Chinese population. Methods: Antero-posterior (AP) and oblique radiographs of 4,417 left and 4,299 right feet obtained from 8,716 patients in the Hebei province of Northern China, and retrospectively examined for the presence of sesamoid bones, identified as a small oval bone plantar to each metatarsophalangeal (MTP) joint and the first interphalangeal (IP) joint. Results and Conclusions: The prevalence rate of a sesamoid bone associated with the first to fifth MTP joints and the first IP joint was 99.96%, 3.08%, 0.39%, 0.69%, 8.94%, and 59.22%, respectively. Moreover, a morphological variation in hallucal sesamoids was identified in 12.09% of feet, with variations classified into three distinct types according to bone size and the number of ossification centers. Ossification begins in the hallucal MTP and IP joints at approximately 8 years of age, with the final ossification center being evidence for the sesamoid bone of the fourth MTP joint at 28 years of age. Relevance for patients: Our study provides important anatomical data regarding the prevalence of sesamoid bones in the forefoot of a large population of Chinese adult and pediatric patients for use in clinical practice and research in forensic science and anthropology.