The flexor hallucis brevis (FHB) has two heads that insert via two separate tendons onto the two sesamoid bones (medial and lateral) of the first metatarsophalangeal joint. Each sesamoid is embedded within the corresponding FHB tendon and is held in position by the plantar plate, the collateral ligaments, and the inter-sesamoid ligament. The FHL tendon passes between the sesamoids in the inter-sesamoid groove.
The FHB bifid insertion at the sesamoids makes both sesamoids stress-bearing structures during push-off. Sesamoiditis (inflammation of the sesamoid and surrounding tissues) produces localised plantar metatarsal head pain worsened by great toe extension and running. Sesamoid fracture (acute or stress fracture) must be distinguished from bipartite sesamoid (a normal variant). The medial sesamoid is more commonly fractured and more commonly involved in sesamoiditis. Sesamoidectomy for chronic refractory sesamoiditis requires meticulous repair of the FHB tendon to avoid hallux valgus or claw toe deformity.
Repetitive push-off loading in runners and dancers produces medial sesamoid stress fracture within the FHB medial tendon, producing plantar first MTP pain worse on toe-off; bone scan and MRI distinguish stress fracture from sesamoiditis and bipartite sesamoid, managed by unloading orthosis and in refractory cases by sesamoidectomy with meticulous FHB repair.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
