The two sesamoid bones of the great toe (medial and lateral sesamoids) are embedded within the flexor hallucis brevis tendon on the plantar surface of the first metatarsal head. They protect the underlying flexor hallucis longus tendon, increase the mechanical advantage of the FHB, and distribute the enormous loads at the first metatarsophalangeal joint during walking (120% body weight) and running (800% body weight).
Sesamoid fractures from direct impact or stress reaction produce plantarflexion-localised pain directly under the first metatarsal head. Bipartite sesamoids (present in 10 to 30 percent of people) are distinguished from fractures by their smooth corticated margins on radiograph and by the absence of acute onset. Sesamoiditis, stress reaction within the sesamoid without frank fracture, produces the same presentation and is managed with cushioned orthotics and activity restriction before considering sesamoid excision.
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