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TIBIAL SESAMOIDECTOMY

When sesamoid disease is present, I am more inclined to perform a sesamoidectomy than to attempt other procedures, such as sesamoid shaving, bone grafting of the sesamoid, or removal of one pole of the sesamoid. Regardless of whether a tibial or a fibular sesamoidectomy is performed, it is essential to be aware of the mechanical changes that take place around the hallux. After tibial sesamoidectomy, the hallux tends to drift into slight hallux valgus with a weakness in push-off strength; even dorsiflexion contracture may occur. After fibularsesamoidectomy, hallux varus, as well as a weakness in push-off strength, may develop. Bone grafting of the sesamoid (e.g., in the setting of a chronic nonunion of the sesamoid) can work. Because of the morbidity associated with this particular procedure, with requirements for non–weight bearing and the potential for persistent nonunion after prolonged rehabilitation, however, sesamoidectomy is a more appealing procedure. The only …