Sesamoidectomy is a surgery to remove one or both sesamoid bones under the big toe. These small bones sit inside the flexor hallucis brevis tendon and help the big toe joint (first metatarsophalangeal, or MTP) move smoothly and bear load. When a sesamoid is fractured, irritated, or fails to heal after rest and bracing, removing the painful bone can relieve symptoms and restore function.
How Common It Is and Who Gets It? (Epidemiology)
Painful sesamoid problems are seen in runners, dancers, court-sport athletes, and people whose jobs or hobbies involve frequent push-off on the big toe. Athletes are prominently represented in published case series of sesamoid fractures requiring surgery.
Why It Happens – Causes (Etiology and Pathophysiology)
Symptoms arise from chronic stress, repetitive motion, or trauma to a sesamoid. When non-operative care (rest, ice, anti-inflammatory medicines, orthotics, immobilization) fails, persistent pain can come from a fracture nonunion or ongoing tendon/bone irritation—prompting consideration of sesamoidectomy.
How the Body Part Normally Works? (Relevant Anatomy)
Two sesamoids (medial and lateral) act like pulleys inside the big-toe flexor tendon to reduce friction and increase the efficiency of push-off. They share force across the first MTP joint and help protect the tendon and joint cartilage during walking and running.
What You Might Feel – Symptoms (Clinical Presentation)
- Pain under the big toe, worse with weight-bearing and push-off
- Tenderness and swelling beneath the first MTP joint
- Pain with walking, running, or rising onto the toes
- Symptoms that persist despite rest, padding, or orthotics
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis begins with exam and pinpoint tenderness under the big toe. X-rays identify fracture or chronic changes. MRI can show bone and tendon irritation or a nonunion. Imaging also helps the surgeon plan the safest approach (medial or lateral).
Classification
Clinically, problems are described by which sesamoid is involved (medial/tibial or lateral/fibular) and pathology type (acute fracture, chronic nonunion, or painful sesamoiditis).
Other Problems That Can Feel Similar (Differential Diagnosis)
Pain in this area can also be due to first MTP joint arthritis, soft-tissue irritation around the joint, or forefoot overload (metatarsalgia). Imaging and a focused exam help distinguish these.
Treatment Options
Non-Surgical Care
- Activity modification, ice, anti-inflammatory medicines
- Padding, off-loading inserts/orthotics, stiff-soled shoes or rocker-bottom shoes
- Short period of immobilization in a boot or cast
Surgical Care
- Sesamoidectomy (removal of the painful sesamoid) through a targeted approach:
- Medial approach for the medial sesamoid (protecting nearby nerves/tendon)
- Lateral/dorsal approach for the lateral sesamoid
- Tendon repair/balancing as needed after excision
Recovery and What to Expect After Treatment
- Post-op shoe or boot; 7–10 days usually non-weight-bearing, then gradual weight-bearing
- Swelling and soreness improve over weeks
- Most patients return to regular activities in 8–12 weeks, depending on approach and healing
Possible Risks or Side Effects (Complications)
- Hallux valgus (bunion-type drift) after medial sesamoidectomy (reported 1 in 24 in one series)
- Metatarsalgia (ball-of-foot pain) from altered load sharing
- Stiffness or decreased big-toe motion
- General risks of surgery (infection, wound irritation, nerve symptoms)
Long-Term Outlook (Prognosis)
Published results show reliable pain relief and return to activity. In one athletic series (n=24), 91.6% returned to activity at a mean 11.6 weeks; pain scores improved from 6.2/10 pre-op to 0.7/10 post-op. Overall, about 90% of athletes return to their pre-injury level.
Out-of-Pocket Cost
Medicare
CPT Code 28315 – Sesamoidectomy (Removal of One or Both Sesamoid Bones in the Foot): $109.30
Medicare Part B typically covers 80% of the approved cost for this procedure after your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved procedures. These plans coordinate with Medicare to fill the coverage gap and reduce patient costs.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining balance, including coinsurance or small deductibles, which generally range from $100 to $300, depending on your plan and provider network.
Workers’ Compensation
If your sesamoidectomy is required due to a work-related injury or repetitive stress condition, Workers’ Compensation will cover all related medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier covers all approved treatments directly.
No-Fault Insurance
If your sesamoid removal is due to an automobile accident, No-Fault Insurance will typically cover the total cost of your treatment, including the surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.
Example
Michael Thompson had a painful sesamoid bone injury that required sesamoidectomy (CPT 28315). His estimated Medicare out-of-pocket cost was $109.30. Since Michael had supplemental insurance through AARP Medigap, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the procedure.
Frequently Asked Questions (FAQ)
Q. What is Sesamoidectomy?
A. Sesamoidectomy is a surgical procedure that involves removing one or both of the sesamoid bones located in the foot, typically in the area of the big toe, to alleviate pain caused by fractures or disorders of these bones.
Q. Why is Sesamoidectomy necessary?
A. It is necessary when a sesamoid fracture or disorder causes persistent pain that does not respond to conservative treatments like rest, ice, anti-inflammatory medications, or orthotics.
Q. How is Sesamoidectomy performed?
A. The procedure involves making an incision near the affected sesamoid bone, carefully excising the bone, and closing the incision. Different approaches are used depending on the location of the sesamoid.
Q. What is the recovery time after Sesamoidectomy?
A. The initial recovery period typically involves 7 to 10 days of non-weight-bearing activity, followed by gradual return to weight-bearing. Full recovery usually takes 8 to 12 weeks.
Q. What are the risks of Sesamoidectomy?
A. Risks include infection, nerve damage, recurrence of symptoms, and changes in foot mechanics, such as pain in the ball of the foot (metatarsalgia).
Q. Can I return to sports after Sesamoidectomy?
A. Most patients can return to sports within 8 to 12 weeks after surgery, depending on the healing progress and the type of activity.
Q. How effective is Sesamoidectomy in providing pain relief?
A. The procedure is highly effective in providing pain relief, with most patients experiencing significant improvement in symptoms, particularly in athletes, with many returning to their pre-injury activity levels.
Q. What are the long-term effects of Sesamoidectomy?
A. Long-term effects include restored function and pain relief, though some patients may experience slight changes in foot mechanics or develop minor complications, which can usually be managed with rehabilitation.
Q. Will I need to wear a cast after Sesamoidectomy surgery?
A. Yes, you will likely need to wear a cast, boot, or special shoe for a few weeks to protect the foot and allow the surgical site to heal properly.
Q. Can both sesamoid bones be removed at the same time?
A. Yes, both sesamoid bones can be removed if necessary, but this depends on the severity of the damage to the bones. The decision is made based on the patient’s condition and the surgeon’s recommendation.
Q. How long will I be unable to walk after Sesamoidectomy?
A. You will need to avoid putting weight on the affected foot for about 2 to 4 weeks, depending on the surgical approach and the specific healing process.
Q. Can Sesamoidectomy cause permanent changes in foot function?
A. While most patients experience long-term pain relief, some may experience changes in foot mechanics, particularly in how pressure is distributed across the foot, which can sometimes lead to discomfort in the forefoot.
Q. Is physical therapy required after Sesamoidectomy?
A. Physical therapy is often recommended to restore strength, flexibility, and normal movement to the foot, especially if the surgery involved extensive recovery.
Q. How effective is Sesamoidectomy in treating sesamoiditis or fractures?
A. Sesamoidectomy is highly effective in treating chronic sesamoiditis or fractures that don’t heal with conservative treatments. It significantly reduces pain and allows most patients to return to normal activities.
Q. What should I do to prevent complications after Sesamoidectomy?
A. To prevent complications, it is important to follow your surgeon’s post-operative instructions, which may include keeping weight off the foot, wearing protective footwear, and attending follow-up appointments to monitor healing.
Q. Can Sesamoidectomy lead to arthritis or other long-term joint issues?
A. Although rare, removing the sesamoid bones can change foot mechanics, potentially increasing stress on other joints in the foot and leading to conditions such as arthritis in the metatarsal joint. Regular follow-up care and appropriate footwear can help manage this risk.
Summary and Takeaway
Sesamoidectomy is a focused, outpatient surgery that reliably relieves stubborn big-toe sesamoid pain when bracing, orthotics, and rest are not enough. With a short protected phase, progressive weight-bearing, and simple rehab, most patients return to work, daily life, and sports within a few months.
Clinical Insight & Recent Findings
A recent study explored how removing the medial sesamoid bone—called a medial sesamoidectomy—can provide valuable graft material for complex or revision first metatarsophalangeal (MTP) joint fusions. In cases where bone loss, failed implants, or prior surgeries made fusion more challenging, surgeons used the patient’s own sesamoid bone as a local autograft.
Among 107 patients, all 24 who underwent this technique achieved successful bone fusion, compared with a 92% fusion rate in standard cases. The study found that this approach may eliminate the need for separate graft sites, reduce surgical time and cost, and avoid additional incisions, while still achieving excellent outcomes.
Though further research is needed, these findings suggest sesamoidectomy can safely double as a graft source during big toe fusion surgery. (“Study on using the medial sesamoid as a local bone graft in big toe fusion – see PubMed.”)
Who Performs This Treatment? (Specialists and Team Involved)
Foot and ankle orthopedic surgeons perform sesamoidectomy. Care often includes a podiatrist, anesthesiologist, and physical therapist for gait training and return-to-sport planning.
When to See a Specialist?
See a specialist if you have ongoing pain under the big toe for weeks despite rest, padding, and footwear changes—especially if push-off is painful or a fracture has been diagnosed.
When to Go to the Emergency Room?
Seek urgent care for severe pain and swelling after an acute injury, numbness in the toe, signs of infection (fever, spreading redness, drainage), or inability to bear weight.
What Recovery Really Looks Like?
Expect a boot or post-op shoe, 7–10 days of limited weight-bearing, elevation/ice for swelling, and a gradual return to walking and low-impact exercise. Many resume normal footwear by 8–12 weeks.
What Happens If You Ignore It?
Persistent sesamoid pain can limit walking and sport, alter gait, and contribute to forefoot overload and secondary problems.
How to Prevent It?
Use cushioned, supportive shoes; consider orthotics for load sharing; avoid sudden spikes in forefoot-loading activities; and address training errors early.
Nutrition and Bone or Joint Health
Prioritize protein, calcium, and vitamin D; stay hydrated; and maintain a balanced diet to support bone and soft-tissue healing.
Activity and Lifestyle Modifications
Return to activity in phases: walking in a boot/post-op shoe → supportive sneakers → low-impact cardio → sport-specific drills. Use rocker-bottom or stiff-soled footwear early to reduce forefoot stress.
Dr. Mo Athar
