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Dorsolateral Excision of the Fibular Sesamoid: Technique and Results

Kurian, Jason MD*; McCall, David A. MD; Ferkel, Richard D. MD

Techniques in Foot & Ankle Surgery: December 2014 - Volume 13 - Issue 4 - p 226–235
doi: 10.1097/BTF.0000000000000066
CME Article

Background: Injuries to the hallucal sesamoid complex are uncommon, but they can cause significant pain. The medial sesamoid is the most common site of pain, but the fibular sesamoid can also become symptomatic. The most common clinical entities that lead to chronic fibular sesamoid pain are fracture nonunion and osteonecrosis. The purpose of this study was to describe the technique and determine the results of the dorsolateral approach for fibular sesamoid excision.

Methods: During an 11-year span, 8 patients underwent fibular sesamoidectomy using a dorsolateral approach after a minimum of 6 months of nonoperative treatment. The mean age was 33 years (range, 22 to 43 y). The average follow-up was 97 months (range, 24 to 167 mo). Patients were assessed using the AOFAS forefoot grading scale and a subjective rating for walking, pain, and overall satisfaction.

Results: Fibular sesamoidectomy was performed for osteonecrosis in 3 patients and for nonunion in 5 patients. Four patients had work-related injuries. Two injuries were due to trauma and the rest were chronic, without a known cause. The average length of nonoperative care was 107 weeks and included rest, injections, physiotherapy, bracing, casting, NSAIDs, and orthotics. Overall, the patient subjective satisfaction was 5 excellent and 3 good. The mean AOFAS forefoot score was 91 and average time to return to activity was 15 weeks. The mean pain rating was 1.3/5, and the mean subjective walking score was 4.625/5.

Discussion: Compared with previously published reports, our results for isolated fibular sesamoidectomy show similar satisfaction rates with equivalent time to return to activities and a low complication rate while avoiding a plantar incision.

Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence.

*Orthopedic Surgeon, Summa Health System, Portland, OR

Orthopedic Surgeon, Palo Alto Medical Foundation, Mountain View, CA

Program Director, Southern California Orthopedic Institute, Van Nuys, CA

Richard D. Ferkel has served as a consultant for Smith & Nephew Inc.; has received royalties from Smith & Nephew Inc. and Lippincott Williams & Wilkins; and received institutional support from Smith & Nephew, DePuy Mitek, and Ossur Medical. His spouse/life partner, if any, have disclosed that they have no relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The remaining authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity.


Techniques in Foot & Ankle Surgery includes CME-certified content that is designed to meet the educational needs of its readers. This activity is available for credit through December 31, 2015.

Earn CME credit by completing a quiz about this article. You may read the article here, on the TFAS website, or in the TFAS iPad app, and then complete the quiz, answering at least 80 percent of the questions correctly to earn CME credit. The cost of the CME exam is $10. The payment covers processing and certificate fees. If you wish to submit the test by mail, send the completed quiz with a check or money order for the $10.00 processing fee to the Lippincott CME Institute, Inc., Wolters Kluwer Health, Two Commerce Square, 2001 Market Street, 3rd Floor, Philadelphia, PA 19103. Only the first entry will be considered for credit, and must be postmarked by the expiration date. Answer sheets will be graded and certificates will be mailed to each participant within 6 to 8 weeks of participation.

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Lippincott Continuing Medical Education Institute, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

Lippincott Continuing Medical Education Institute, Inc., designates this journal-based CME activity for a maximum of 1 (one) AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Address correspondence and reprint requests to Richard D. Ferkel, MD, Southern California Orthopedic Institute, 6815 Noble Ave., Van Nuys, CA 91405. E-mail:

© 2014 by Lippincott Williams & Wilkins