Management and Outcomes of Hallucal Sesamoid Osteomyelitis

Area of Science:

• Orthopedic Surgery
• Podiatric Medicine
• Infectious Disease Management

Background:

• Foot osteomyelitis management typically involves extensive bone debridement and resection.
• The sesamoid apparatus is anatomically complex, situated near the first metatarsal head.
• Current practice often involves isolated resection of infected sesamoids, potentially overlooking broader implications.

Purpose of the Study:

• To evaluate the outcomes of isolated sesamoidectomy for osteomyelitis.
• To determine the rate at which patients progress to partial first-ray resection after sesamoidectomy.

Main Methods:

• Retrospective review of 24 patients undergoing sesamoidectomy for osteomyelitis.
• Data collected over a 14-year period (2007-2021) at a single institution.
• Diagnosis confirmed via radiography or MRI, interpreted by an independent radiologist.

Main Results:

• High complication rate of 63% (15 patients), frequently necessitating revisional surgery.
• Significant progression to partial first-ray resection in 37.5% (9 patients).
• Majority of patients (92%) had diabetes, 50% smoked, and all had neuropathy.

Conclusions:

• Isolated sesamoidectomy is associated with a high complication rate and increased need for further surgical intervention.
• The findings suggest that isolated sesamoidectomy may not provide sufficient margins for effective debridement in osteomyelitis.
• Progression to more extensive procedures, including amputation, is a notable outcome.