The tibial sesamoid ligament connects the medial (tibial) sesamoid to the medial FHB head tendon, the medial MTP capsule, and the abductor hallucis insertion.
Provides the primary medial constraint for the tibial sesamoid and maintains its position within the medial plantar first MTP complex.
Tibial sesamoid avascular necrosis (Renander disease) is more common than fibular sesamoid AVN and produces plantar first MTP pain requiring offloading and occasionally sesamoid excision for refractory cases.
Avascular necrosis of the medial sesamoid producing chronic plantar first MTP pain and sesamoid fragmentation on X-ray, managed by offloading orthotics or sesamoid excision.
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