Sesamoidectomy is indicated for the treatment of a discrete intractable lesion, beneath the 1st metatarsal head, that fails to heal or remain healed with a conservative approach to treatment (local wound care, total-contact casting or attempts to off-load the forefoot with orthoses and custom footwear). Sesamoidectomy is also indicated for the curative treatment of osteomyelitis of the sesamoid bone. This procedure is appropriate for the treatment of neuropathic patients with evidence of increased plantar pressure beneath the 1st metatarsal head. Weightbear-ing radiographs taken with a radio-opaque open circle marker placed over the ulcer will confirm the relationship between an enlarged or arthritic sesamoid bone and the plantar lesion. There may also be evidence of a plantar flexed 1st metatarsal associated with a cavus foot deformity. Excision of the tibial sesamoid, fibular sesamoid or both sesamoids maybe indicated.

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