Management and Outcomes of Hallucal Sesamoid Osteomyelitis

Osteomyelitis in the foot is routinely managed by wide-scale debridement and surgical resection of infected bone. Appropriate debridement is important for optimizing patient success. The sesamoid apparatus is a complex area of foot anatomy with a mosaic of osseous and soft-tissue attachments adjacent to the first metatarsal head. Despite this, in the setting of an infected sesamoid, most providers resect only an isolated infected sesamoid. The aim of this study was to review outcomes of isolated surgical sesamoidectomy in the setting of osteomyelitis and how many may progress to partial first-ray resection.

We retrospectively reviewed 24 patients who underwent sesamoidectomy for osteomyelitis at a single institution by one primary surgeon during a 14-year period (2007-2021). Diagnosis was made by the surgeon and verified by conventional radiography or magnetic resonance imaging interpretation by an independent radiologist.

Of the 24 patients, 22 (92%) were diabetic, 12 (50%) smoked, and all had a history of neuropathy. This study revealed a 63% complication rate (n = 15), which led to revisional surgery and often progression to more proximal amputation. Nine patients (37.5%) progressed to partial first-ray resection.

This study exposed a high complication rate correlating with progression to additional surgery (P = .05), strongly suggesting that isolated sesamoidectomy may not definitively provide clear enough margins during operative debridement.