Effect of sesamoid position on functional outcome of operated hallux valgus

The loss of correct relationships between the sesamoid and the first metatarsal is one of the architectural consequences of the hallux valgus (HV). The reduction of this dislocation by lateral soft tissue release (LSTR) is one of the objectives of surgery.

To study the relationship between postoperative position of sesamoid and clinical outcome at one-year postoperative follow-up.

It's a retrospective study including patients operated for evolved HV performed in la Rabta orthopedic department in Tunis. These patients had a Scarf osteotomy associated with at least one Weil osteotomy. The functional evaluation was based on the AOFAS score (American-orthopedic-foot-and-ankle-society). We classified the sesamoid position according to 3 scores: Hardy & Clapham , RCAOFAS and the Agrawal. We compared each score of the sesamoid position to the clinical outcome.

We collected 46 cases of HV in 45 patients. The mean AOFAS score increased from 60,9 to 85,5/100 postoperatively. Our patients were divided into 2 groups: group A whose result was excellent and group B whose result was good, fair and poor. The analytical study of this work concluded that there was no relationship between the postoperative sesamoid position and the clinical outcome, regardless of the radiological classification used (p=0,361, p=0,222, p=0,260).

Sesamoids that remain in postoperative dislocation are not necessarily predictive of a poor clinical outcome at one year of the surgical cure.