Sesamoiditis Treatment: Is Surgery Indicated?

Non-surgical treatments for sesamoiditis

Surgical intervention is rarely proposed to treat sesamoiditis. Non-surgical alternatives may be sufficient except in cases of infectious diseases of the sesamoids.

Orthopedic orthosis

The orthosis for sesamoiditis is a functional and non-invasive solution. It helps support the foot and reduce pressure on the sesamoid bones by offloading them. The orthosis is designed to fit the shape of the foot perfectly, offering optimal comfort while providing adequate immobilization for recovery.

Orthopedic insoles for sesamoiditis

Orthopedic insoles for sesamoiditis are another valid non-surgical option. They are customized to meet the specific anatomy of each patient. These insoles help distribute weight evenly across the entire foot, thus relieving pressure on the sesamoid bones by creating a pressure-relief recess. They can be worn in everyday shoes, making them a practical solution.

Foot surgery for sesamoiditis

Foot surgery for sesamoiditis is considered when non-surgical treatments have not provided the expected relief. At the Foot Clinic, we treat sesamoid disorders of the hallux, except for infectious sesamoid pathologies in diabetic patients, which require specialized multidisciplinary hospital management.

What is the role of surgery in cases of sesamoiditis?

Surgery may be considered when pain persists despite conservative treatments. The decision to perform a surgical procedure depends on several factors, including the severity of symptoms, the impact on quality of life, and the response to non-surgical treatments.

Surgical procedures for sesamoiditis

Several types of surgical procedures for sesamoiditis can be considered depending on the cause and the painful sesamoid.

• Sesamoid excision, known as sesamoidectomy, involves the complete removal of the painful sesamoid. Sesamoidectomy can be performed arthroscopically.
• Osteosynthesis involves surgically stabilizing a fracture or pseudoarthrosis of the sesamoid with osteosynthesis material. Osteosynthesis is often combined with a bone graft.
• Thinning of a sesamoid can be performed by percutaneous burring in cases of plantar conflict.
• Metatarsophalangeal arthrorisis is the temporary blocking of the metatarsophalangeal joint and allows neutralization of traction forces on the sesamoids during bone healing.

Recovery and rehabilitation after sesamoiditis surgery

The postoperative period following surgery of the plantar sesamoid of the hallux varies depending on the lesions and the surgical procedure performed.

Rehabilitation after surgery for sesamoiditis

Rehabilitation after surgery of the hallux sesamoids can last for very different periods depending on the procedure performed. Thinning of the sesamoid by percutaneous burring allows for immediate but protected weight-bearing, while osteosynthesis of a fracture or treatment of a sesamoid pseudarthrosis may require a 6-week non-weight-bearing period.

Initially, the focus is on reducing swelling and managing pain. Subsequently, gentle mobilization exercises are introduced to restore foot function. As healing progresses, these exercises become more intense, aiming to strengthen the intrinsic and extrinsic muscles of the foot and improve joint mobility.