Disorders > Treatments
When conservative treatment does not heal your sesamoid
disorder, or if you have lost blood supply in the area,
your physician may recommend surgery to remove the damaged
sesamoid from your foot. Removing one sesamoid typically
does not affect your ability to walk or run, but some
patients may lose a little strength and range of motion
in their big toes. You should talk with your physician
about the possible effects of sesamoid excision on your
sports and activities.
The actions you take before surgery
can be every bit as important as the procedure itself
in ensuring a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will
go to “patient admissions” to check in for
your operation. There may be separate check-in areas
for ambulatory outpatient (patients go home the same
day after surgery) and for overnight inpatient surgery,
so be sure to ask your doctor or an assistant about
this. After you have checked in to the hospital, you
will go to a holding area where the final preparations
are made. The mandatory paperwork is completed, and
your foot may be shaved, though this is not always necessary.
You will be asked to change into a hospital gown and,
if applicable, remove your watch, glasses, dentures,
and jewelry. You will have the opportunity to speak
with your orthopedic surgeon or an assistant and meet
the anesthesiologist or nurse anesthetist (a nurse who
has done graduate training to provide anesthesia under
the supervision of an anesthesiologist). Then, you will
walk or ride on a stretcher to the operating room. Most
patients are not sedated until they go into the operating
room. Here are some important steps to remember for
the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
for someone to drive you home when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your splint when you
leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgical excision of your sesamoid
typically takes about 1½ hours to perform. A
local anesthetic, called an ankle block, is injected
into your ankle to numb your foot. You usually are sedated
so you sleep through the procedure.
small incision, about two centimeters long, typically
is made on the top part of your foot at the base of
your big toe, either on the inside or outside of the
big toe. The incision’s location depends on which
sesamoid is removed.
tendon (flexor hallucis brevis) covering the sesamoid
is opened and the bone is cut away from the tendon and
removed from your foot.
damaged soft tissue is repaired.
tendon is sewn back together and tightened so that it
continues functioning normally.
incision is closed with stitches. A splint is applied
to immobilize your foot and ankle, and you are taken
to the recovery room.
After your sesamoid is removed, you
will be transported to the recovery room where you will
be closely observed for one to two hours while the immediate
effects of anesthesia and sedatives wear off. Your foot
will be elevated and immobilized in a plaster splint
when you wake up. There usually is minimal bleeding
after surgery. You typically cannot see the incision
in your foot because it is wrapped in the splint. The
dressing around your wound helps stabilize your big
toe in the proper position. Try to keep your toe still
and your foot relaxed. After surgery, you usually experience
some pain. Adequate pain medications will be prescribed
for you. You will be given intravenous (IV), oral, or
intramuscular pain medications as needed. Your surgeon
typically prescribes crutches and you are usually instructed
to keep weight off your foot for the first few weeks.
You may meet a physical therapist in the hospital who
helps you learn to get around using crutches. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse who, with the help of the doctor, will determine
when you can prepare to go home. Most patients leave
the hospital the same day after surgery. Make sure to
have someone available to drive you home, as you will
be unable to drive a car.
For four to five days after your sesamoid
is removed, you should keep off your feet, elevate your
foot above heart level, and move around the house as
little as possible. You should try to rest and avoid
too much movement for at least a week. Crutches usually
are prescribed for one to two weeks so you can keep
your body weight off your foot. Rest as much as possible
with your foot elevated. This helps blood drain away
from your foot and can control swelling. Household tasks
that require you to be on your feet may be difficult
for two to four weeks. Try to have someone around the
house to help with any physical chores. The dressing
covering your wound inside your post-surgery foot splint
usually does not need to be changed until the splint
is removed. It is important that the dressing remains
wrapped around your big toe securely to help hold the
toe in position. If the dressing comes loose, you should
call your physician. When the dressing is no longer
needed, your physician may recommend taping your big
toe in position. There is a risk after your sesamoid
is removed of what is called toe “migration”.
This means your big toe may become slightly deformed.
Taping your toe in position for two to eight weeks after
surgery can help your toe heal correctly. Your physician,
nurse, or trainer can tape your big toe if necessary.
Though each case is different, a typical follow-up schedule
after you leave the hospital may go as follows:
to 10 days – Stitches come out and your splint
is removed. Most patients are put into a removable brace
called a cam walker that immobilizes your ankle and
has a solid bottom so your toes do not bend.
to four weeks – Slowly return to bearing some
weight on your foot as you can tolerate the pain. Most
patients can begin moving their big toe two to three
weeks after surgery but the toe should remain taped
to avoid deformity. Always wear the cam walker or cast
shoe when putting any weight on your foot. You ordinarily
rely less and less on the crutches for support as pain
to six weeks – You typically can cease wearing
the cam walker and return to normal shoe wear.
to eight weeks – More vigorous walking exercises
usually can begin. Start with short distances and do
not walk farther than pain allows.
Formal physical therapy may not be
necessary after surgery to remove your sesamoid. Many
patients can adequately restore motion and strength
in their big toe with a regular cardiovascular exercise
program. Most patients can return to sports and activities
within two or three months after surgery. Begin exercising
with short walks and increase the duration and intensity
as pain allows. Start lightly stretching your big toe
about two to three weeks after surgery, as instructed
by your physician. You may be able to use stationary
cycles or swim without causing much pain in your foot
three to four weeks after the injury. When your pain
is gone, start with low impact exercises. Progress to
light jogging before sprinting, jumping, and cutting.
More vigorous running and exercise typically can begin
within eight weeks after surgery. Gradually return to
activities with pain as your guide. Understand that
your level of activity prior to the injury was somewhere
above your foot’s threshold to withstand the forces
and stress of that activity. Increase your workouts
slowly, and if pain returns, decrease the intensity
and duration of your walks, runs, or other physical
Formal physical therapy may not be necessary after surgery
to remove your sesamoid. Many patients can adequately
restore motion and strength in their big toe with a
regular cardiovascular exercise program. Most patients
can return to sports and activities within two or three
months after surgery. Begin exercising with short walks
and increase the duration and intensity as pain allows.
Start lightly stretching your big toe about two to three
weeks after surgery, as instructed by your physician.
You may be able to use stationary cycles or swim without
causing much pain in your foot three to four weeks after
the injury. When your pain is gone, start with low impact
exercises. Progress to light jogging before sprinting,
jumping, and cutting. More vigorous running and exercise
typically can begin within eight weeks after surgery.
Gradually return to activities with pain as your guide.
Understand that your level of activity prior to the
injury was somewhere above your foot’s threshold
to withstand the forces and stress of that activity.
Increase your workouts slowly, and if pain returns,
decrease the intensity and duration of your walks, runs,
or other physical activities.
The best way to prevent reinjury in
your big toe is to be sure that it is flexible and strong
before you begin repetitive running, jumping, and cutting
motions. Though are not at risk of reinjuring your sesamoid
after it has been removed, you do need to prevent what
is called post-operative drift or migration of your
big toe out of position. Continue taping your big toe
daily for up to eight weeks after surgery. It is a good
idea to continue toe taping when exercising or engaging
in activities for three or four months after surgery.
To prevent loss of range of motion and strength in your
big toe, you should make stretching and weight bearing
aerobic exercise part of your everyday routine. The
risk of injuring your remaining sesamoid is small. However,
returning to activities before your pain has gone away
and increasing your activity level too quickly may cause
pain and symptoms to flare up. Remember the level of
exercise you were performing when the initial injury
occurred and slowly work your way back. Proper footwear,
designed for your particular sport or activity, can
help protect your foot against abnormal strain in your
big toe joint. Avoid wearing old, worn-out shoes when
you are running or participating in activities that
pound your feet. In general, shoes with higher heels
put more strain on the ball of your foot and should
be avoided. Depending on the shape of your foot, you
may benefit from orthotic devices molded to decrease
the strain that passes through the ball of your foot
when you walk or run. Your physician typically has these
molded for you if necessary. If you plan on returning
to competitive sports or rigorous activities, you may
benefit from visiting a physical therapist. Therapists
can help teach you plyometric training techniques, such
as jump training with boxes or steps. Proprioceptive
training, which includes balancing on a BAPS board atop
a round ball, also can help improve the resiliency and
coordination of the muscles that move your big toe.