The FHB tendon contains the two sesamoid bones of the great toe within its two heads, wrapping around the plantar first metatarsal head to insert on the great toe proximal phalanx. The medial sesamoid bears more load than the lateral and fractures more commonly. Turf toe involves the FHB plantar plate and sesamoid complex at the first MTP joint from hyperextension loading.
Great toe MTP flexion force; sesamoid complex load distribution
Sesamoiditis and sesamoid stress fractures within the FHB produce plantar first MTP pain reproduced by direct sesamoid palpation and great toe dorsiflexion. MRI distinguishes acute fracture from chronic stress reaction and bipartite sesamoid. Sesamoid excision relieves refractory sesamoiditis but risks hallux valgus or varus deformity depending on which sesamoid is removed.
FHB sesamoid fracture from repetitive loading producing plantar first MTP pain managed with cushioned orthotics and activity restriction before considering sesamoid excision.
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