Sesamoidectomy

Sesamoidectomy is a surgical procedure involving the removal of one or both of the sesamoid bones located in the foot, typically under the big toe joint. These small, pea-shaped bones are embedded within tendons and play a crucial role in absorbing pressure and facilitating movement. When conservative treatments fail to alleviate pain or resolve conditions like sesamoiditis or sesamoid fractures, a sesamoidectomy may be recommended.

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A sesamoidectomy is the surgical removal of a sesamoid bone, often performed to relieve chronic pain, correct deformities, or address non-healing fractures in the sesamoid bones. This procedure can involve either the tibial (inner) or fibular (outer) sesamoid bone, or in some cases, both.

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General Considerations

Before opting for a sesamoidectomy, several factors must be considered:

• 1. Non-Surgical Treatments: Exhausting all conservative treatments, such as rest, orthotics, physical therapy, and medication, is crucial.

• 2. Patient Evaluation: A thorough evaluation of the patient's medical history, activity level, and specific symptoms is essential to determine suitability for surgery.

• 3. Imaging Tests: X-rays, MRIs, or CT scans are often performed to assess the condition of the sesamoid bones and surrounding tissues.

• 4. Potential Outcomes: Understanding the potential benefits, risks, and long-term implications of the surgery is vital for informed decision-making.

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Surgical Technique

The surgical technique for a sesamoidectomy typically follows a series of steps to effectively address the condition:

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Prior to the procedure, the patient receives either regional or general anesthesia to ensure a pain-free experience. A small incision is carefully made over the area where the affected sesamoid bone is located.

Exposure: Dr. Kamel gently moves aside soft tissues to expose the sesamoid bone, ensuring clear access to the targeted area. Once exposed, the damaged or problematic sesamoid bone is meticulously removed by Dr. Kamel. Following the removal, the incision is meticulously closed using sutures, and a sterile dressing is applied to the surgical site to facilitate proper healing.

It's important to note that the exact technique employed during the sesamoidectomy may vary depending on factors such as the specific sesamoid bone being removed and the underlying condition being addressed.

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Recovery

• Immediate Post-Operative Care: Patients are advised to keep the foot elevated and apply ice to reduce swelling. Pain management typically involves prescribed medications.

• Immobilization: The foot may be immobilized using a cast or a stiff-soled shoe to protect the surgical site and promote healing.

• Weight-Bearing: Initially, weight-bearing on the affected foot is limited. Gradual reintroduction of weight-bearing activities is guided by the surgeon.

• Physical Therapy: A tailored physical therapy program helps restore strength, flexibility, and range of motion.

• Follow-Up Visits: Regular follow-up appointments with the surgeon ensure proper healing and address any concerns.

Recovery time can vary, but most patients return to normal activities within a few months.

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Risks and Complications

While sesamoidectomy is generally safe, potential risks and complications include:

• Infection: As with any surgical procedure, there is a risk of infection.

• Nerve Damage: Potential for nerve injury leading to numbness or tingling in the toe.

• Persistent Pain: Some patients may continue to experience pain even after the sesamoid bone is removed.

• Joint Instability: Removal of a sesamoid bone can lead to instability in the big toe joint.

• Delayed Healing: Prolonged recovery period or complications in the healing process.

Sesamoidectomy is a valuable surgical option for individuals suffering from chronic pain or dysfunction in the sesamoid bones that do not respond to non-surgical treatments. Understanding the procedure, recovery process, and potential risks can help patients make informed decisions and achieve the best possible outcomes. If you are considering a sesamoidectomy, consult with Dr. Kamel to discuss your specific condition and treatment options.