The hallucal sesamoid ligament is the fibrocartilaginous connection between the two sesamoid bones of the great toe, maintaining their anatomical relationship within the FHB tendon system.
| Origin | Tibial (medial) sesamoid of the hallux |
|---|---|
| Insertion | Fibular (lateral) sesamoid of the hallux |
Maintains the relationship between the medial and lateral sesamoids, allows some relative movement between them, and is disrupted in bipartite sesamoid or sesamoid fracture patterns.
The intersesamoid ligament binds the medial and lateral sesamoids together around the FHL tendon, and its disruption in sesamoid fracture or severe turf toe can let the sesamoids separate. Bipartite sesamoid (developmental) must be distinguished from acute fracture by smooth rounded edges and frequent bilateral occurrence. In hallux valgus the first metatarsal head drifts medially off the sesamoids, which stay tethered to the second metatarsal by the deep transverse metatarsal ligament and adductor hallucis, so the sesamoids appear displaced laterally on radiographs; correction relies on realigning the metatarsal over them.
Acute sesamoid fracture disrupting the intersesamoid ligament producing sesamoid separation on stress X-ray, managed by immobilisation or sesamoid excision for non-union.
Congenital bipartite sesamoid with smooth rounded sesamoid edges distinguished from acute fracture on plain X-ray, confirmed by bilateral X-ray and bone scan if uncertain.
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