Tibial sesamoidectomy: indications and outcomes

Abstract

Background: Medial sesamoidectomy has been reported to be a safe and effective means of treating a range of pathologies including chronic sesamoiditis and fracture nonunion. The purpose of this case series is to determine common clinical indications for medial sesamoidectomy and to evaluate the postoperative clinical course and outcomes. Methods: A retrospective chart review was conducted on patients who had isolated medial sesamoidectomy from 2009 to 2018. Demographics, comorbidities, physical exam variables, operative findings, radiographic measurements including hallux valgus angle (HVA) and intermetatarsal angle (IMA), and clinical outcomes including visual analog score (VAS), Foot Function Index (FFI), and complications were gathered. Results: Twenty-six patients (13 males and 13 females) were identified to have undergone tibial sesamoidectomy with a mean age of 49.8±18.5 years. VAS improved significantly (5.27±2.41 to 0.91±1.14, P<0.01). Mean postoperative FFI was 132.75±50.68. There was no statistically significant change in IMA (8.35º±1.87ºto 8.29º±1.79º, P=0.93) or HVA (14.94º±6.82ºto 14.28º±7.78º, P=0.79). At 15.6±5.37 weeks, four of five patients had resolution of preoperative ulceration. There was a 17% incidence of complications including neuritis, transfer metatarsalgia, and persistent cock-up deformity. Conclusions: Isolated tibial sesamoidectomy, when utilized judiciously and with the right indications can improve pain and ulcer healing.