Sesamoidectomy is a surgical procedure that involves the removal of one or both of the sesamoid bones located in the foot, specifically in the area of the big toe. These small bones are nestled within the tendons of the flexor hallucis brevis muscle, which helps with the movement of the big toe. They play a vital role in the functionality of the first metatarsophalangeal joint by helping to transmit force and reduce friction as you walk, run, and perform other activities.
Why is Sesamoidectomy Needed?
Sesamoid fractures and disorders can result from chronic stress, trauma, or repetitive motion. When conservative treatments like rest, ice, anti-inflammatory medications, and orthotics do not provide relief, surgery may be necessary. A condition such as a hallux sesamoid fracture, which is common in athletes, may require sesamoidectomy if it does not heal with nonoperative treatments.
Symptoms Leading to Surgery
A sesamoid fracture or disorder often presents with pain in the bottom of the big toe, especially when bearing weight. The pain may worsen with activities like walking, running, or pushing off the ground. Swelling and tenderness around the area may also be observed. If these symptoms persist despite conservative treatments, a sesamoidectomy may be considered.
The Procedure: How is Sesamoidectomy Performed?
The procedure typically involves making an incision near the affected sesamoid bone. Depending on the fracture’s location, the surgeon may take different approaches to access the bone.
Medial Approach: For medial sesamoid fractures (on the inner side of the big toe), the surgeon makes an incision along the inside of the foot. This approach allows for careful excision of the sesamoid bone while protecting important structures like nerves and tendons.
Lateral Approach: For fractures on the outside of the foot, a dorsal incision (on the top of the foot) is made, providing access to the lateral sesamoid. Again, the bone is carefully removed, and surrounding tendons are repaired.
The bone is then excised, and the remaining structures are sutured closed. The procedure usually takes less than an hour and is done on an outpatient basis, meaning you can go home the same day.
Recovery and Postoperative Care
After surgery, patients are advised to wear a postoperative shoe or walking boot for support. The initial recovery period typically involves 7 to 10 days of non-weight-bearing activity, followed by gradual return to weight-bearing as tolerated. Most patients can return to normal activities in approximately 8 to 12 weeks, depending on the location of the fracture and the surgical approach used.
Patients can expect significant pain relief after surgery. In one study, pain levels dropped dramatically from an average of 6.2 (on a scale of 0 to 10) before the surgery to 0.7 after the procedure.
Benefits of Sesamoidectomy
Pain Relief: The primary benefit of sesamoidectomy is relief from pain. Removing the damaged bone allows patients to resume their regular activities without discomfort.
Faster Recovery for Athletes: For athletes or highly active individuals, sesamoidectomy offers a quicker return to physical activities compared to other treatments like surgical fixation. On average, patients return to activity within 11.6 weeks after the procedure.
Improved Functionality: Many patients find that their overall foot function improves after surgery, with fewer issues related to the big toe and surrounding joints.
Risks and Complications
While sesamoidectomy is generally safe, it does carry some risks, as with any surgical procedure. Common complications include:
Hallux Valgus (Bunion-like Deformity): In some cases, especially after medial sesamoidectomy, patients may develop hallux valgus, which is a deformity of the big toe that points outward. This occurred in one patient out of 24 in a study following medial sesamoidectomy.
Metatarsalgia (Pain in the Ball of the Foot): Some patients may develop pain in the ball of the foot after the surgery, especially if the removal of the sesamoid alters the mechanics of walking.
Stiffness or Decreased Range of Motion: Occasionally, stiffness in the big toe joint can develop, making it harder to bend the toe.
Despite these potential risks, the overall complication rate after sesamoidectomy is relatively low, with most patients returning to their normal activities without significant issues. The success rate for athletes returning to sports at their pre-injury level is about 90%.
Conclusion
Sesamoidectomy is a highly effective surgical solution for those suffering from symptomatic hallux sesamoid fractures or disorders. For individuals who do not respond to conservative treatments, it provides significant pain relief and a good chance of returning to normal activity within a few months. However, as with any surgery, it carries risks and potential complications, so it is important to discuss all available options with your orthopedic surgeon.
Do you have more questions?
Q. What is Sesamoidectomy?
A. Sesamoidectomy is a surgical procedure that involves removing one or both of the sesamoid bones located in the foot, typically in the area of the big toe, to alleviate pain caused by fractures or disorders of these bones.
Q. Why is Sesamoidectomy necessary?
A. It is necessary when a sesamoid fracture or disorder causes persistent pain that does not respond to conservative treatments like rest, ice, anti-inflammatory medications, or orthotics.
Q. How is Sesamoidectomy performed?
A. The procedure involves making an incision near the affected sesamoid bone, carefully excising the bone, and closing the incision. Different approaches are used depending on the location of the sesamoid.
Q. What is the recovery time after Sesamoidectomy?
A. The initial recovery period typically involves 7 to 10 days of non-weight-bearing activity, followed by gradual return to weight-bearing. Full recovery usually takes 8 to 12 weeks.
Q. What are the risks of Sesamoidectomy?
A. Risks include infection, nerve damage, recurrence of symptoms, and changes in foot mechanics, such as pain in the ball of the foot (metatarsalgia).
Q. Can I return to sports after Sesamoidectomy?
A. Most patients can return to sports within 8 to 12 weeks after surgery, depending on the healing progress and the type of activity.
Q. How effective is Sesamoidectomy in providing pain relief?
A. The procedure is highly effective in providing pain relief, with most patients experiencing significant improvement in symptoms, particularly in athletes, with many returning to their pre-injury activity levels.
Q. What are the long-term effects of Sesamoidectomy?
A. Long-term effects include restored function and pain relief, though some patients may experience slight changes in foot mechanics or develop minor complications, which can usually be managed with rehabilitation.
Q. Will I need to wear a cast after Sesamoidectomy surgery?
A. Yes, you will likely need to wear a cast, boot, or special shoe for a few weeks to protect the foot and allow the surgical site to heal properly.
Q. Can both sesamoid bones be removed at the same time?
A. Yes, both sesamoid bones can be removed if necessary, but this depends on the severity of the damage to the bones. The decision is made based on the patient’s condition and the surgeon’s recommendation.
Q. How long will I be unable to walk after Sesamoidectomy?
A. You will need to avoid putting weight on the affected foot for about 2 to 4 weeks, depending on the surgical approach and the specific healing process.
Q. Can Sesamoidectomy cause permanent changes in foot function?
A. While most patients experience long-term pain relief, some may experience changes in foot mechanics, particularly in how pressure is distributed across the foot, which can sometimes lead to discomfort in the forefoot.
Q. Is physical therapy required after Sesamoidectomy?
A. Physical therapy is often recommended to restore strength, flexibility, and normal movement to the foot, especially if the surgery involved extensive recovery.
Q. How effective is Sesamoidectomy in treating sesamoiditis or fractures?
A. Sesamoidectomy is highly effective in treating chronic sesamoiditis or fractures that don’t heal with conservative treatments. It significantly reduces pain and allows most patients to return to normal activities.
Q. What should I do to prevent complications after Sesamoidectomy?
A. To prevent complications, it is important to follow your surgeon’s post-operative instructions, which may include keeping weight off the foot, wearing protective footwear, and attending follow-up appointments to monitor healing.
Q. Can Sesamoidectomy lead to arthritis or other long-term joint issues?
A. Although rare, removing the sesamoid bones can change foot mechanics, potentially increasing stress on other joints in the foot and leading to conditions such as arthritis in the metatarsal joint. Regular follow-up care and appropriate footwear can help manage this risk.
Dr. Mo Athar
