When It’s Indicated
Chronic, persistent pain at one of the sesamoids beneath the first metatarsal head - usually the result of fracture nonunion, avascular necrosis, or chronic sesamoiditis - that has not responded to immobilization, orthotic offloading, and selected injection.
What’s Done
Excision of the painful sesamoid through a small plantar or medial incision, with care to preserve the function of the flexor hallucis brevis tendon. Most patients retain normal great-toe function.
Recovery
Stiff postoperative shoe for 4–6 weeks, gradual return to regular footwear and activity over 8–12 weeks. Pain relief is reliable in well-selected patients.