What is a Sesamoid Bone? The Sesamoid Bones are two bones on the bottom of the big toe joint, specifically underneath the head of the first metatarsal. These bones help the tendons that go through the big toe joint to glide through the joint. Think of your Sesamoid bones as a knee cap of the big toe joint. Now usually this type of fracture can be seen on a regular x-ray, although sometimes, we may need MRI to really pick up the Sesamoid fracture. The treatment for this type of fracture consists of shoe and lifestyle modification. What that means is wearing a shoe that exerts as little pressure on that area as possible. Usually a flat shoe with a lot of cushioning such as a sneaker or even a rocker-bottom shoe. If the pain persists with that kind of treatment, then patients may go into a cam-walker or a ski-boot type of walker which takes all the pressure off the big toe joint. And, for patients who fail that type of treatment, and this would really be a last resort, there is surgical removal of the Sesamoid bones after which you can walk and still function very, very well. So, if you or someone you know has been having pain on the bottom of the big toe joint and it’s not getting better, it’s a good idea to come in for an evaluation and an x-ray to see if you might have a Sesamoid bone fracture.