Foot pain can significantly limit mobility and quality of life, especially when it involves structures essential for walking, running, and balance. One lesser-known but critically important structure in the foot is the sesamoid bone. When this small bone becomes injured or diseased and conservative treatments fail, a surgical procedure known as sesamoidectomy may be recommended. Although it sounds complex, sesamoidectomy is a well-established operation that has helped many patients return to a pain-free and active lifestyle.

This article provides a detailed, easy-to-understand guide to sesamoidectomy, including what it is, why it is performed, how recovery works, and what patients can expect in the long term.

Understanding Sesamoid Bones in the Foot

Sesamoid bones are small, round bones embedded within tendons. In the foot, there are usually two sesamoid bones located beneath the big toe joint (the first metatarsophalangeal joint). These bones sit within the tendons of the flexor hallucis brevis muscle and play a crucial role in foot mechanics.

The primary functions of sesamoid bones include:

• Absorbing weight-bearing pressure

• Acting as pulleys to improve tendon leverage

• Assisting with push-off during walking and running

• Stabilizing the big toe joint

Because the sesamoids bear a large amount of force with every step, they are especially vulnerable to injury, particularly in athletes, dancers, and individuals who spend long hours on their feet.

What Is a Sesamoidectomy?

A sesamoidectomy is a surgical procedure that involves removing part or all of a sesamoid bone from the foot. In most cases, only one sesamoid is removed to preserve normal biomechanics of the big toe. Complete removal of both sesamoids is rare and generally avoided due to the risk of joint instability.

The goal of sesamoidectomy is to relieve chronic pain while maintaining as much function and balance in the foot as possible.

Conditions That May Require Sesamoidectomy

Sesamoidectomy is usually considered only after non-surgical treatments have failed. Conditions that may lead to this procedure include:

Sesamoiditis

A chronic inflammatory condition caused by repetitive stress or overuse. Pain is often localized under the ball of the foot and worsens with activity.

Sesamoid Fractures

Acute fractures or stress fractures that fail to heal properly can lead to ongoing pain and impaired function.

Avascular Necrosis

A condition in which the blood supply to the sesamoid bone is disrupted, causing bone tissue to die and collapse.

Arthritis

Degenerative joint changes affecting the sesamoid bones or the big toe joint.

Chronic, Unrelenting Pain

Persistent pain that interferes with daily life despite prolonged conservative treatment.

Conservative Treatments Attempted First

Before surgery is considered, most patients undergo months of non-surgical management, which may include:

• Rest and activity modification

• Anti-inflammatory medications

• Custom orthotics or padding to offload pressure

• Immobilization with a walking boot

• Physical therapy

• Corticosteroid injections (used cautiously due to risk)

Sesamoidectomy is generally recommended only when these treatments fail to provide lasting relief.

Preoperative Evaluation and Planning

Before performing a sesamoidectomy, the surgeon conducts a thorough evaluation. This typically includes:

• Physical examination of foot alignment and gait

• Imaging studies such as X-rays, MRI, or CT scans

• Assessment of tendon balance and joint stability

Careful planning is essential to determine which sesamoid should be removed and to minimize disruption to surrounding structures.

How the Sesamoidectomy Procedure Is Performed

Sesamoidectomy is commonly performed as an outpatient procedure under regional or general anesthesia.

Surgical Approach

The surgeon makes a small incision, either on the top or bottom of the foot, depending on the affected sesamoid and underlying condition. The damaged sesamoid bone is carefully removed while protecting surrounding tendons, nerves, and blood vessels.

Surgical Precision

Maintaining tendon balance is critical. Surgeons take special care to avoid weakening the flexor tendons that control big toe movement, as imbalance can lead to deformities or altered gait.

Procedure Duration

The surgery typically lasts less than one hour, though preparation and recovery time add to the overall visit.

Risks and Possible Complications

While sesamoidectomy is generally safe, potential risks include:

• Infection

• Delayed wound healing

• Nerve irritation or numbness

• Scar sensitivity

• Persistent swelling

• Changes in gait mechanics

• Development of hallux valgus (bunion)

• Reduced push-off strength

Selecting an experienced foot and ankle surgeon significantly reduces the likelihood of complications.

Recovery After Sesamoidectomy

Immediate Postoperative Phase

Patients are usually placed in a surgical shoe or boot and advised to limit weight-bearing. Elevation and ice help manage swelling and discomfort.

Weight-Bearing Progression

Most recovery protocols follow this general timeline:

• First 2–4 weeks: Limited or partial weight-bearing

• Weeks 4–6: Gradual increase in walking

• Weeks 6–8: Transition to regular footwear

Individual recovery times vary depending on the procedure and patient health.

Role of Physical Therapy

Physical therapy is an essential component of recovery. A structured rehabilitation program helps restore:

• Toe range of motion

• Tendon flexibility and strength

• Proper gait mechanics

• Balance and coordination

Skipping physical therapy may increase the risk of stiffness, weakness, or long-term functional limitations.

Returning to Sports and Activities

For non-athletes, normal daily activities often resume within two to three months. Athletes and highly active individuals typically require more time.

• Low-impact exercise: 8–10 weeks

• Running and jumping: 3–6 months

• High-level athletics: Up to 6 months or longer

Gradual progression is key to preventing re-injury.

Long-Term Outcomes and Success Rates

Most patients who undergo sesamoidectomy experience significant pain relief and improved function. Long-term outcomes are generally positive when:

• Only one sesamoid is removed

• Proper rehabilitation is followed

• Foot alignment is carefully managed

While some patients notice subtle changes in toe strength or balance, these are often minimal and do not interfere with daily life.

Who Is a Good Candidate for Sesamoidectomy?

Ideal candidates typically:

• Have persistent sesamoid-related pain for several months

• Have failed conservative treatments

• Do not have severe foot deformities

• Are motivated to complete rehabilitation

A thorough discussion with a foot and ankle specialist is essential before deciding on surgery.

Conclusion

Sesamoidectomy is a specialized but effective surgical option for individuals suffering from chronic sesamoid pain that does not respond to conservative care. Although the sesamoid bones are small, their impact on foot mechanics is significant, making careful surgical technique and proper rehabilitation essential.

When performed for the right reasons and followed by structured recovery, sesamoidectomy can restore comfort, mobility, and confidence—allowing patients to return to the activities they enjoy without persistent foot pain.