What if You Need Surgery?

Whether you need to have surgery and the type of surgery you'll have depends on the severity of your sesamoiditis and whether you have a fracture in your bone. The longer you've waited to have surgery or try conservative treatment methods will also be a factor to decide if you need surgery.

Has it been weeks or months since the injury?

An acute (recent) case of sesamoiditis is usually treated with conservative treatment methods, like rest, minimizing activity, cold compression and Blood Flow Stimulation Therapy^™ as we mentioned before.

Doctors and surgeons will always avoid surgery if possible because recovery from the surgery can be a lengthy process, in most cases your sesamoid bones will have to be removed reducing the mobility of your foot. Doctors always prefer minimally invasive treatments which is why they suggest conservative treatment first. Your doctor and surgeon know that a surgery will involve altering the structure of your foot, and so they will recommend treatment to avoid surgery at all costs.
If you have a fracture that's not healing of you have a fracture that puts your bone in multiple pieces, your surgeon might perform a sesamoidectomy (removal of the sesamoid bone).
Scar tissue will be problematic for long-term recovery after surgery.

As with any surgery there are risks to every procedure depending on a lot of factors, including your age, the severity of your injury and your level of health going into the procedure. It's always best to discuss all possible risks and complications with your doctor, orthopaedic specialist and/or surgeon before the procedure. It's important to be aware of the risks you may face with any procedure intended to fix or relieve pain from your sesamoiditis.

Sesamoidectomy

If you suffer from a regular (acute) fracture or stress (chronic) fracture in your sesamoid bone and conservative treatment methods haven't been successful in healing or relieving pain, then your doctor may suggest a sesamoidectomy surgery. During this procedure your fractured or injured sesamoid bone (or pieces of the bone) will be removed. Removal of this bone is meant to ease pain and promote healing in the area.
This procedure will be done by making an incision on the side of your big toe. The surgeon will then seperate all of the underlying soft tissues to get to your sesamoid bones and visually inspect it. Once removing some or all of your sesamoid bone the surgeon will use sutures to attach the end of the tendons together or connect it to the remaining bone.

One of the major risks of this surgery is how removal of your sesamoid bone(s) will affect the structure of your foot. Since the sesamoid bones act as pulley's on the bottom of the foot for tendons that control your toes, removal of one or both of these bones will remove important leverage needed for the foot to work properly. There is always a risk that removal of your sesamoid bone(s) could affect the shape or angle of your big toe. You might end up with 'claw toe' (where your big toe is bent up) or your big toe could slant towards your second toe. You could also end up needing to have the rest of your sesamoid bone left removed if it gets fractured in the future.

This is why doctors encourage conservative treatment methods first, and surgery only second IF the conservative methods of healing don't work.

Sesamoid Bone Graft Surgery

The only other option for sesamoid surgery is a bone graft. This is usually only performed when you continue to have issues with a stress (chronic) fracture in your sesamoid bone(s). During this procedure your surgeon will take some bone from big toe (this is called an 'autogenous bone graft') through a second incision, and then use that bone to repair the areas that aren't healing properly in your sesamoid.

Sesamoidectomy is always preferred over a bone graft as it's a minimally invasive surgery. This bone graft procedure is also only ever considered for high performance athletes.

Your rate of recovery after the surgery will depend on how dedicated you are to the conservative treatment method recommended by your doctor, the type of procedure that you had and your efforts in physical therapy.

No two rehabilitation plans are alike - Generally speaking the less invasive your
surgery is, the quicker your road to recovery will be.

• Sesamoidectomy - You may need to wear a cast for 2 to 3 weeks, then follow that with a walking brace for another few weeks. Physical therapy can start 2 to 3 weeks after your surgery and you may be able to return to some modified form of your regular activity by week 8.

• Sesamoid Bone Graft Surgery - This procedure will have a longer recovery period, starting with you wearing a cast for 3 to 4 weeks. That's followed by a walking cast or boot to be worn for another 3 to 4 weeks. Physical therapy may start anywhere from 4 weeks after surgery to 8 weeks after surgery. Other assistive devices like orthotics or arch supports may be prescribed to help you along with your recovery.