title: Fact or fiction? Iatrogenic hallux abducto valgus secondary to tibial sesamoidectomy.
abstract: First ray function and hallux misalignment after isolated tibial sesamoidectomy have been topics of debate. Although sesamoidectomy has been proved to be effective in the relief of sesamoid pain, many foot and ankle surgeons remain hesitant to perform the procedure fearing a possible joint perturbation. To our knowledge, the present study is the first to evaluate both laboratory and clinical evidence of the association between isolated tibial sesamoidectomy and hallux abducto valgus deformity. The bench study consisted of 10 cadaveric limbs that were dissected and prepared for testing. Controlled valgus loads were applied before and after tibial sesamoidectomy. No significant difference was found in the joint position after sesamoidectomy in both the rectus (p = .36) and the dorsiflexed (p = .062) positions. The clinical evaluation consisted of a retrospective cohort of 5 females; all of whom underwent isolated tibial sesamoidectomy. The pre- and postoperative radiographs and self-reported pain scores (visual analog scale) were compared. None of the patients developed a postoperative hallux abducto valgus deformity. Neither the hallux abductus angle (p = .180) nor the intermetatarsal angle 1-2 (p = .180) changed significantly in the postoperative setting. The visual analog scale pain scores changed from a mean of 6.8 to 1, a significant difference (p = .042). Based on our observations and clinical experience, we believe that isolated tibial sesamoidectomy does not have a significant effect on the position of the first metatarsophalangeal joint when meticulous surgical technique is used to excise the sesamoid. Isolated tibial sesamoidectomy can provide substantial pain relief and appears to be a safe treatment for a variety of conditions affecting the tibial sesamoid.
authors.affiliation: Private Practice, St. Vincent Medical Group, Rockside Physician's Center, Independence, OH; Associate Director, PMSR/RRA Residency Training Program, Department of Orthopedic Surgery, St. Vincent Charity Medical Center, Cleveland, OH; and Professor, Department of Surgery, Kent State University College of Podiatric Medicine, Independence, OH.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Canales
authors.affiliation: Adjunct Faculty, Kent State University College of Podiatric Medicine, Independence, OH; and Private Practice, Beachwood, OH.
authors.forename: Matthew
authors.initials: M
authors.lastname: DeMore
authors.affiliation: Fellow, Weil Foot and Ankle Institute, Des Plaines, IL.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Bowen
authors.affiliation: Postgraduate Year 3 Resident, PMSR/RRA Residency Training Program, St. Vincent Charity Medical Center, Cleveland, OH. Electronic address: duane.ehredt.jr@gmail.com.
authors.forename: Duane J
authors.initials: DJ
authors.lastname: Ehredt
authors.affiliation: Postgraduate Year 2 Resident, PMSR/RRA Residency Training Program, St. Vincent Charity Medical Center, Cleveland, OH.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Razzante
mesh_terms: D002102:Cadaver; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D019637:Orthopedic Procedures / Q000009:adverse effects; D011859:Radiography; D012189:Retrospective Studies; D012716:Sesamoid Bones / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: bunion; cadaver bench study; flexor hallucis brevis; metatarsophalangeal joint; sesamoid; visual analog scale