Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Sesamoid pathology can cause significant impairment of foot function, resulting in chronic pain, compromised mobility, and reduced quality of life. Initial conservative management typically consists of orthotics, injections, or physical therapy. Recalcitrant symptoms may necessitate surgery. While sesamoidectomy is typically recommended when conservative measures fail, the procedure lacks standardized postoperative guidelines, and few studies have investigated the long-term effects of sesamoidectomy. Therefore, more knowledge about postoperative complications such as biomechanical alterations, gait disturbance, and chronic pain is imperative. In this study functional outcomes following sesamoidectomy were evaluated at midterm postoperative follow-up in comparison to preoperative function.
Methods:
Institutional review board approval was obtained (IRB 20020136), and a retrospective cohort study was conducted on patients who underwent sesamoidectomy performed by four surgeons between 2014 and 2024. Patient data were retrieved from an institutional database, and outcomes were assessed using Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL) scores, Visual Analog Scale (VAS) pain scores, and Foot and Ankle Ability Measure Sports (FAAM Sp) scores. Only patients with both preoperative and postoperative outcome data were included. Descriptive statistics were applied to all collected metrics, and differences in scores were analyzed using a one-way ANOVA with Tukey post hoc tests for pairwise comparisons. Additionally, the Minimal Clinically Important Difference (MCID) and Minimal Detectable Change (MDC) were calculated using distribution-based methods.
Results:
41 patients met the inclusion criteria for this study. The mean follow-up period was 11.9 months. FAAM ADL scores significantly improved from 64.8 ± 18.9 preoperatively to 79.1 ± 16.0 postoperatively (P < 0.001). Among these patients, 21 (50%) achieved the MCID of 10.2 points, while 13 (30.9%) achieved the MCD of 25.2 points. VAS pain scores also showed significant improvement, decreasing from 4.3 ± 2.4 to 2.8 ± 2.6 (P < 0.01). 7 patients identifying as athletes demonstrated notable improvement, with FAAM Sp scores increasing from 35.3 ± 20.9 to 67.3 ±28.4 (P < 0.01). There were no patients in this study who sustained complications or required postoperative hospitalization or associated reoperation.
Conclusion:
Sesamoidectomy can be an effective surgical treatment option for sesamoid pathology refractory to conservative management, resulting in substantial pain relief and functional restoration long-term. A more robust study with a larger sample size and longer postoperative follow-up is indicated to refine decision making and optimize long-term results as it pertains to sesamoidectomy outcomes. Strengthening clinical guidelines will enhance patient selection and postoperative care, ensuring better outcomes for patients with forefoot dysfunction due to sesamoid bone pathology.
Demographics and Postoperative Outcomes in Sesamoidectomy Patients
FAAM ADL - Foot and Ankle Ability Measure Activities of Daily Living; FAAM Sp - Foot and Ankle Ability Measure Sports; VAS - Visual Analogue Scale; N - total number of patients; SD - Standard Deviation; BMI - Body Mass Index; P -p-value (**statistically significant**)