The lateral sesamoid ligament connects the fibular (lateral) sesamoid to the lateral proximal phalanx base and lateral MTP capsule. The fibular sesamoid also receives the lateral head of flexor hallucis brevis and the adductor hallucis.
| Origin | Fibular (lateral) sesamoid of the hallux |
|---|---|
| Insertion | Lateral plantar base of the proximal phalanx of the hallux |
Provides the primary lateral constraint for the fibular sesamoid, maintaining its position during push-off and MTP movement.
In hallux valgus the fibular sesamoid comes to lie lateral to the first metatarsal head, partly from adductor hallucis pull and mostly because the metatarsal drifts medially; lateral soft tissue release and metatarsal osteotomy restore alignment. Lateral sesamoid avascular necrosis can follow lateral MTP capsular release in hallux valgus surgery if the sesamoid blood supply is disrupted alongside the lateral ligament.
Lateral sesamoid ligament and capsule disruption during lateral release damaging the sesamoid blood supply and producing avascular necrosis.
Progressive lateral position of the fibular sesamoid relative to the metatarsal head, corrected by lateral soft tissue release and first metatarsal osteotomy.
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