The clinical scenario is consistent with a tibial sesamoid fracture recalcitrant to conservative management. Tibial sesamoidectomy would be the most appropriate and reliable treatment to return the patient back to sports.
Sesamoid fractures can occur in the foot as a result of forced dorsiflexion of first the first MTP. They can be distinguished from a bipartate sesamoid by increased activity on a bone scan.
Lee et al. evaluated hallux alignment and functional outcome after isolated tibial sesamoidectomy. They concluded that a hallux deformity after sesamoidectomy can be avoided by surgical repair of the soft tissues and that isolated tibial sesamoidectomy is a safe and effective treatment for recalcitrant tibial sesamoiditis.
Saxena et al. looked at the return to activity after sesamoidectomy in athletically active individuals. They found athletically active individuals were able to return to sports after a sesamoidectomy as early as 7.5 weeks. They concluded that sesamoidectomy of the first MTP joint in athletically active patients may be indicated in cases of chronic sesamoiditis resistant to nonsurgical care or symptomatic displaced fractures or nonunion.
Figure A shows a radiograph of a tibial sesamoid fracture. Figure B shows a bone scan of a sesamoid fracture showing increased activity.
Answer 2: This would be appropriate in the setting of a turf toe, by would not address the fractured tibial sesamoid.
Answer 3: This is a treatment option in the setting of mild arthritis for the 1st MTP joint.
Answer 4: This is a treatment option for a fractured tibial sesamoid, but would take more time to return athletes to sport compared to simple tibial sesamoidectomy.
Answer 5: This is a treatment option for bunion surgery.
Lee S, James WC, Cohen BE, Davis WH, Anderson RB. Evaluation of hallux alignment and functional outcome after isolated tibial sesamoidectomy. Foot Ankle Int. 2005 Oct;26(10):803-9.
PMID:16221451 (Link to Abstract)
Saxena A, Krisdakumtorn T. Return to activity after sesamoidectomy in athletically active individuals. Foot Ankle Int. 2003 May;24(5):415-9.
PMID:12801198 (Link to Abstract)