Name of the Procedure:

Sesamoidectomy, First Toe (Sesamoid Bone Removal, Hallux Sesamoidectomy)

Summary

A sesamoidectomy involves the surgical removal of one or both sesamoid bones located beneath the first toe (big toe). These small bones can cause pain and difficulty walking if damaged or arthritic.

Purpose

The procedure addresses chronic pain, inflammation, or fractures in the sesamoid bones. The goal is to alleviate discomfort, restore proper toe function, and allow for improved mobility.

Indications

• Persistent pain beneath the first toe unresponsive to conservative treatments
• Chronic inflammation or arthritis in the sesamoid bones
• Fractures or structural abnormalities of the sesamoid bones
• Osteonecrosis (bone death) of the sesamoid bones

Preparation

• Pre-operative fasting typically required if general anesthesia will be used
• Adjustment of certain medications (e.g., blood thinners) as advised by the physician
• Pre-operative imaging studies like X-rays or MRI to assess the sesamoid bones
• Consultation with an anesthesiologist

Procedure Description

1. Anesthesia: The patient is given regional or general anesthesia to ensure comfort.
2. Incision: A small incision is made near the base of the first toe.
3. Bone Removal: The surgeon carefully removes the damaged or problematic sesamoid bone(s).
4. Closure: The incision is closed using sutures or surgical staples.
5. Dressing: A sterile dressing is applied to protect the surgical site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is typically performed in an outpatient surgical center or hospital.

Personnel

• Orthopedic or podiatric surgeon
• Anesthesiologist or nurse anesthetist
• Operating room nurses and surgical technicians

Risks and Complications

• Infection at the surgical site
• Delayed or poor wound healing
• Nerve damage leading to numbness or tingling
• Incomplete relief of pain
• Adverse reactions to anesthesia
• Bone misalignment or biomechanical issues in the foot

Benefits

• Significant reduction or elimination of pain
• Improved mobility and ability to walk without discomfort
• Return to normal activities and footwear

Recovery

• Initial days: Rest and elevation of the foot, icing to reduce swelling
• Pain management through prescribed medications
• Gradual return to weight-bearing activities as advised by the surgeon
• Physical therapy may be recommended to restore strength and range of motion
• Full recovery can take several weeks to a few months, depending on individual healing rates
• Follow-up appointments to monitor progress and address any concerns

Alternatives

• Conservative treatments like physical therapy, orthotic devices, and anti-inflammatory medications
• Injections (e.g., corticosteroids) to manage pain and inflammation
• Surgery to realign or repair part of the sesamoid bones without removal

Patient Experience

• During the procedure: Most patients do not experience pain due to anesthesia
• Post-procedure: Mild to moderate pain managed with medications, potential swelling and bruising
• Encouraged to rest and limit movement initially, gradually increasing activity as healing progresses
• Continuous follow-up with the healthcare team to ensure a smooth recovery process