Your sesamoids are two small bones under the base of your big toe that help provide leverage for normal toe biomechanics. Every time the ball of your foot strikes the ground, weight is transferred through your sesamoids. Functioning like your kneecap, your sesamoids enable your toe joint to bend with more strength and stability. Overuse of your big toe typically causes a sesamoid disorder. Runners, cyclists, and people who abruptly increase their training regimen are at an increased risk of suffering a sesamoid disorder if they overuse the muscles and tendons that bend their big toes. 

Loss of blood supply in your sesamoids is rare, but it can be caused whenever damage in the tissue surrounding the sesamoids decreases their blood supply. If the blood supply to these small bones is compromised, a diagnosis known as Avascular necrosis (AVN) can ensue. AVN of the sesamoid is pathology of the medial or lateral hallucal sesamoid resulting in pain under the first metatarsophalangeal joint often presenting in young female athletes. There is overlap of stress fracture, nonunion, and AVN that makes defining the diagnosis difficult but the treatment and outcomes are similar. Often advanced imaging such as CT scan, bone scan or MRI is necessary to make the exact diagnosis. Nonoperative modalities are designed to offload the sesamoid. Boot immobilization and a non-weightbearing protocol can be effective in the acute sages of deformity. Use of a bone stimulator daily can help physiological healing of the bones. Transition into a special orthotic with a cutout modification for these bones can be very effective to reduce symptoms and allow for pain-free gait. AVN that is advanced can lead to fragmentation and atrophy of the sesamoids. The only operative treatment used for AVN of the sesamoid is excision of the involved bone, which results most commonly in complete patient satisfaction. Please schedule a timely evaluation if you feel sharp pain under the great toe to determine if your sesamoids are the cause!

Nearly 100 bunionectomy procedures have been described in surgery literature. This variety exists because surgeons take into account the severity of the deformity, the quality of the involved joints, the quality of the bone, the age of the patient, and many other factors. While some of these procedures have fallen out of favor due to new technology and discoveries in surgical techniques, one procedure known as the Lapidus bunionectomy has withstood the test of time.

Bunion correction is more nuanced than simply removing the “bump” from the great toe. A bunion is a deformity that can occur in all three planes of the human body and often involves the 1^st metatarsal bone splaying away from the 2^nd metatarsal bone. Therefore, correction often involves creating a bone cut in the first metatarsal bone, shifting it back into place, and inserting a screw to maintain the newly corrected position. When the deformity is more severe and the 1^st metatarsal is splayed far from the 2^nd metatarsal, the correction is achieved more towards the middle of the foot to get a better lever arm for correction. In these severe cases, or in individuals who have laxity of the midfoot, the Lapidus bunionectomy is the procedure of choice.

The Lapidus bunionectomy involves fusing the 1^st metatarsal bone to its neighboring bone of the midfoot known as the cuneiform. By fusing this joint farther back on the foot, a higher level of correction can be achieved for these severe cases. Because this fusion occurs at the origin of the deformity, patients who undergo this procedure have the lowest recurrence rates of their bunion deformities. Traditionally, the correction and fusion were maintained by wires or screws. Because these implants are less stable, patients would have to be placed in a cast for up to 8 weeks then slowly transitioned back to sneakers. However, with the advent of newerimplants and techniques, patients no longer require casts and may be walking on their foot within weeks of the surgery!

The doctors of Advanced Podiatry have much experience in performing the Lapidus bunionectomy. We carefully select patients who are the right candidates for this more technical type of bunionectomy, and our results speak for themselves!