Functional Outcomes Following Hallux Sesamoidectomy in Athletic and Non-Athletic Populations at Two-Year Follow-Up

Background: The hallucal sesamoids are 2 small ovoid bones embedded within the flexor hallucis brevis tendon beneath the first metatarsophalangeal joint. Pathology of these structures can significantly impair foot function, resulting in pain, limited mobility, and reduced quality of life. When conservative treatment fails, surgical excision may be indicated. However, sesamoidectomy remains relatively uncommon, lacks standardized management guidelines, and has limited long-term outcome data. The purpose of the study was to evaluate postoperative functional outcomes following sesamoidectomy using validated patient-reported outcome measures in patients with persistent hallux sesamoid pathology refractory to conservative management, with emphasis on pain and functional improvement in athletes. Methods: A retrospective cohort study was conducted on patients who underwent sesamoidectomy between 2014 and 2024 at a single institution. Data were obtained from a secure database. Outcomes included visual analog scale (VAS) pain scores and Foot and Ankle Ability Measure activities of daily living (FAAM ADL) and Sports (FAAM Sp) scores. Patients with both preoperative and postoperative data were included. Descriptive statistics were calculated, and score differences were analyzed using 1-way analysis of variance with Tukey post hoc testing. Results: Forty-two patients met inclusion criteria, including 23 athletes. The mean age was 39.9 ± 19.8 years, and mean BMI was 28.9 ± 6.6. Average follow-up was 2.3 years. FAAM ADL scores improved from 61.2 ± 17.3 to 84.7 ± 16.7 ( P < .001), with 78.6% achieving Minimal Clinically Important Difference and 57.1% exceeding Minimal Detectable Change thresholds. VAS pain decreased from 4.6 ± 2.5 to 2.7 ± 2.9 ( P < .001). PROMIS Physical Health scores improved from 13.2 ± 2.0 to 15.8 ± 3.2, and PROMIS Mental Health scores improved from 13.9 ± 2.9 to 15.9 ± 3.2 (both P < .001). Athletes demonstrated significant improvement in FAAM Sports scores (39.7 ± 25.8 to 80.8 ± 26.1, P < .001). Conclusion: Sesamoidectomy was associated with meaningful pain relief and functional improvement in patients with refractory hallucal sesamoid pathology, particularly athletes. Although outcomes are encouraging, larger studies with longer follow-up are needed to define long-term durability. Level of Evidence: Level III, retrospective comparative study.