You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what sesamoid excision technique prevent hallux deformity means and what works. Call (810) 206-1402 to book at Howell or Bloomfield Township.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Sesamoid Excision: Tibial vs. Fibular, Surgical Technique, a relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Appointments in Howell + Bloomfield Township: (810) 206-1402.
Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.
Watch: Dr. Tom Biernacki, DPM
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Sesamoidectomy — surgical excision of the medial (tibial) or lateral (fibular) sesamoid bone of the first metatarsophalangeal joint — is the definitive treatment for avascular necrosis, osteomyelitis, irreparable fracture, and refractory sesamoiditis that has failed all conservative measures. The procedure carries a significant risk of iatrogenic hallux valgus (after tibial sesamoidectomy) or hallux varus (after fibular sesamoidectomy) from disruption of the flexor hallucis brevis tendon balance — and careful anatomical FHB repair and tendon rebalancing are the critical technical steps that determine whether the patient has a good functional result or an iatrogenic deformity worse than the original condition.
Indications and Preoperative Planning
Sesamoidectomy indications: avascular necrosis (MRI confirmed) refractory to prolonged offloading (>6 months); osteomyelitis from plantar ulceration that cannot be eradicated without bone removal; irreparable comminuted fracture nonunion; chronic sesamoiditis >12 months with failed conservative care (orthotics, dancer’s pad, cortisone injection). Choosing which sesamoid to excise: always excise only one sesamoid — bilateral sesamoidectomy produces severe instability of the first MTP joint, hallux valgus, and loss of push-off function; if only one sesamoid is pathological, excise only that one; if both are involved (rare — diabetic osteomyelitis), alternative procedures should be considered. Tibial (medial) sesamoid risk — hallux valgus: the tibial sesamoid crista (medial crease) and FHB medial head insertion are the primary stabilizers of the hallux against lateral drift; resection destabilizes the medial column and allows the hallux to drift laterally from the FHB lateral head’s unopposed pull. Fibular (lateral) sesamoid risk — hallux varus: conversely, fibular sesamoidectomy with FHB lateral head disruption allows medial drift (hallux varus).
Surgical Technique and FHB Repair
Tibial sesamoidectomy approach: medial plantar approach (not dorsal medial — the dorsal approach risks the hallux plantar-medial digital nerve); direct dissection onto the sesamoid avoiding the FHB medial tendon; sharp periosteal dissection of the sesamoid from the surrounding FHB tendon capsule; complete excision with osteotomes preserving as much FHB tendon as possible. FHB repair (critical step): the remaining FHB medial head tendon is advanced and repaired to the medial capsule and the plantar plate with non-absorbable sutures; the repair must be performed under sufficient tension to prevent medial capsule insufficiency; excessive plantar-medial capsular release increases hallux valgus risk. Fibular sesamoidectomy: lateral plantar approach; FHB lateral head tendon preserved and advanced; conjoined tendon of the FHB lateral head and adductor hallucis repaired to restore lateral stability. Postoperative: protected weight-bearing in a postoperative shoe × 4–6 weeks; hallux position monitored on weight-bearing X-rays at 6 weeks; early deformity addressed with K-wire or splinting. Dr. Biernacki at Balance Foot & Ankle performs sesamoidectomy with anatomic FHB repair to prevent hallux deformity at our Bloomfield Township and Howell offices. Call (810) 206-1402.
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Our board-certified podiatrists treat this condition at two convenient locations. Book online 24/7 at either office.
More Podiatrist-Recommended Foot Health Essentials
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Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
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When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers online booking 24/7 at our Howell and Bloomfield Township clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Township
Frequently Asked Questions
Can bunions be corrected without surgery?
Bunion correctors and orthotics cannot reverse a bunion, but they can significantly reduce pain, slow progression, and improve function. Surgery is the only way to permanently correct the deformity — but conservative care often manages symptoms effectively for years.
How long does bunion surgery recovery take?
Recovery varies by procedure. Most patients are in a surgical boot for 4–6 weeks, return to regular shoes at 8–12 weeks, and are fully recovered with normal footwear at 3–6 months. Minimally invasive techniques often have faster recovery.
Do bunions come back after surgery?
Recurrence rates are low with modern surgical techniques (5–10%). Risk is reduced by wearing appropriate footwear after surgery and using custom orthotics to correct the underlying biomechanics that caused the bunion.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Township Office
43494 Woodward Ave, #208
Bloomfield Township, MI 48302
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Most Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — appointments at our Howell and Bloomfield Township offices.
More Sesamoiditis Guides from Dr. Tom
Need treatment? Learn about in-office sesamoiditis treatment at Balance Foot & Ankle, or call (810) 206-1402 to book an appointment.
