Sesamoiditis=NSAIDS, activity modification, full-length shoe orthosis with a metatarsal pad and a relief beneath the 1st MT head
tibial sesamoid stress fracture, the initial treatment of choice is cast immobilization. Excision, partial excision, and bone grafting are reserved for refractory cases. Cortisone injections, taping, and pads do not adequately immobilize the sesamoid. (ahss MH: The sesamoids of the hallux. Clin Orthop 1981;157:88-97.
Excision is the treatment of choice for persistent sesamoid pain that has failed to respond to nonsurgical management. This is true whether the cause of the pain is sesamoiditis, fracture, or osteonecrosis. The fibular sesamoid can be excised via a dorsal or plantar approach. In high-level athletes who have an acute fracture that has progressed to a nonunion, bone grafting has had some success (Anderson RB, McBryde AM Jr: Autogenous bone grafting of hallux sesamoid nonunions. Foot Ankle Int 1997;18:293-296.)
Shaving of the tibial sesamoid is considered the treatment of choice for discreet hyperkeratotic lesions under the tibial sesamoid that fail to respond to conservative management. Dorsiflexion osteotomy is reserved for a large, diffuse intractable plantar keratosis under the entire metatarsal head
Gout (Reber PU, Patel AG, Noesberger B, et al: Gout: Rare cause of hallucal sesamoid pain: A case report. Foot Ankle Int 1997;18:818-820: Mair SD, Coogan AC, Speer KP, et al: Gout as a source of sesamoid pain. Foot Ankle Int 1995;16:613-616.)
The most significant complication after partial excision of the tibial sesamoid is injury to the medial plantar cutaneous nerve through the plantar medial approach
Sesamoid Follow-up Care
Sesamoid Review References
Coughlin MJ: Sesamoid pain: Causes and surgical treatment, in Green WB (ed): Instructional Course Lectures XXXIX. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1990, pp 23-35.