What inserts or precautions are recommended when walking again after excision of fibular sesamoid and how long should the patient be non-weightbearing after surgery?

Post-Operative Management After Fibular Sesamoidectomy

After fibular sesamoidectomy, patients should remain non-weight bearing for 2 weeks, followed by protected weight bearing with a boot that limits dorsiflexion for an additional 4 weeks. 1

Non-Weight Bearing Period

• Patients should remain completely non-weight bearing for the first 2 weeks after fibular sesamoidectomy to protect the surgical site and allow initial healing 1, 2
• During this period, the foot should be elevated when possible to minimize swelling and promote healing 1
• Cryotherapy can be applied during the first postoperative week to help reduce pain and inflammation 3

Transition to Protected Weight Bearing

• After the initial 2-week non-weight bearing period, patients should transition to protected weight bearing using a walking boot that specifically limits dorsiflexion 1
• The walking boot must be designed to prevent excessive strain on the surgical site while allowing functional recovery 1
• Protected weight bearing should continue for approximately 4 weeks (weeks 3-6 post-surgery) 1, 4

Footwear and Inserts

• When transitioning out of the boot (around 6 weeks post-surgery), patients should use shoes with:
  • Stiff soles to minimize dorsiflexion of the first metatarsophalangeal joint 1
  • Adequate arch support to redistribute pressure away from the sesamoid region 1
• Custom orthotic inserts with metatarsal padding are recommended to:
  • Offload pressure from the first metatarsal head 1
  • Provide cushioning to the surgical area 1
  • Redistribute weight to other parts of the foot 4

Rehabilitation Protocol

• Isometric exercises for the intrinsic foot muscles can begin around week 3 when protected weight bearing starts 3
• Active range of motion exercises for the hallux should be initiated by week 4 to prevent stiffness 3, 4
• Progressive strengthening of the hallux flexors should begin around week 6 to restore strength that may be affected by the sesamoidectomy 4
• Full return to normal footwear and activities typically occurs between 8-12 weeks post-surgery, depending on individual healing and functional recovery 4

Precautions and Monitoring

• Patient compliance with weight bearing restrictions and use of protective devices is crucial to prevent complications 1
• Regular follow-up appointments should be scheduled at 2 weeks, 6 weeks, and 12 weeks post-surgery to monitor healing and adjust the rehabilitation protocol as needed 4
• Patients should be monitored for signs of hallux valgus development, although research shows that isolated fibular sesamoidectomy does not typically affect hallux alignment 4

Common Pitfalls to Avoid

• Allowing early unprotected weight bearing can lead to increased pain, delayed healing, and potential complications 1
• Removing the protective boot too early before adequate healing can compromise surgical outcomes 1
• Neglecting to use appropriate footwear with metatarsal support after transitioning out of the boot can lead to increased pressure on the surgical site 4
• Returning to high-impact activities too quickly can cause setbacks in the recovery process 4