Surgical approaches for hallucal sesamoid excision

Abstract

When encountering a patient with hallucal sesamoid pain, a specific diagnosis should be established. This is accomplished with a thorough history and physical examination, a comprehensive differential diagnos is, and timely diagnostic testing. Diagnosis will dictate treatment , which can vary significantly depend ing on the pathology invo lved. Conservative treatment is usually attempted initially followed by surgical treatment if conserva tive treatment fails and the patient is unable to function at his or her desired level of activity. Various surgical options for sick are available (Table 1). Sesamoidectomy has always been a prime consideration as one of the surgical procedures for alleviating symptoms of chronic sesamoid disorders though specific complications related to this surgery can occur and should be considered (Table 2). If the surgeon decides excision of one or both of the hallucal sesamoids is indic ated, the surgica l approach must be carefully considered, as controversy exists as to the best approach. This article reviews preferred surgical approaches for sesamoid excision based on blood supply to the hallucal sesamoids. Biomechanical implication on function of the first metatarsophalangeal joint after sesamoid extirpation is also reviewed.