Endoscopic Plantar Partial Sesamoidectomy for the Management of Metatarsalgia of the First Metatarsal Head After Arthrodesis of the First Metatarsophalangeal Joint.

Abstract

First metatarsophalangeal arthrodesis has been used to treat various pathologies of the great toe with good clinical outcome. First metatarsal head metatarsalgia can occur after first metatarsophalangeal arthrodesis. Surgery is indicated if conservative measures cannot alleviate the symptoms. If there is isolated excessive plantar pressure of the first metatarsophalangeal joint without significant sagittal deformity of the first metatarsophalangeal joint, plantar partial ostectomy of the sesamoid bone(s) is indicated. The purpose of this technical note is to describe the technical details of endoscopic plantar partial sesamoidectomy for the management of metatarsalgia of the first metatarsal head after arthrodesis of the first metatarsophalangeal joint. This all-endoscopy approach allows partial ostectomy of the sesamoid bone from its plantar side dorsally and is a more direct approach than arthroscopic sesamoidectomy to eliminate the plantar pressure point. The extent of partial ostectomy can be titrated according to the intraoperative assessment of plantar pressure distribution across the metatarsal heads. The aim is to eliminate the pressure point underneath the first metatarsal head without excessive bone removal and create excessive pressure underneath the second metatarsal head.