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.
