While chronic sesamoid pain can be difficult to treat, with a precise surgical technique and a strong postoperative rehabilitation program, return to sport is possible, researchers say.
Return to Sport Still Possible Despite Chronic Sesamoid Pain
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Secondary#returntosport#chronicsesamoidpain#surgicaltechnique
In “Functional Outcome of Sesamoid Excision in Athletes,” published online on October 23, 2020 in The American Journal of Sports Medicine, the researchers collected data on patient-reported outcomes and return to sports in athletes after undergoing sesamoidectomy.
They hypothesized that the proper surgical technique and a well-structured rehabilitation protocol would produce promising long-term patient outcomes.
The sesamoid bones of the metatarsophalangeal joint of the big toe play an important role in athletic activity. Athletes can develop sesamoiditis, a painful inflammation of a sesamoid bone and surrounding tendons and tissue. The bones are also subject to the same wear and tear of other bones.
All of the 82 patients included in the study had a sesamoidectomy between January 2006 and September 2015 at the same surgeon’s practice. The plantar structures were all adequately repaired after excision. Mean follow-up was 31.3 ± 26.0 months.
There were 54 medial, 18 lateral, and 10 medial and lateral sesamoid excisions. The majority of the patients were female, with a mean age of 44.9 ±20.2 years.
Twenty-six of the patients were competitive athletes. All the study participants including the athletes saw significant improvement in the 12-item Short Form Health Survey results, the Single Assessment Numeric Evaluation questionnaire results, visual analog scale score and the Foot Function Index-Revised score (p < .05).
Eighty percent of the athletes were able to return to competitive sports at a mean of 4.62 ± 1.01 months after surgery. The median satisfaction score was 97.5%.
The researchers wrote that “this study confirms that with a meticulous surgical technique and a dedicated postoperative rehabilitation program, encouraging patient-reported outcomes can be expected with a minimal risk of complications.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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