The hallucal sesamoids are part of the capsuloligamentous complex over the plantar aspect of the metatarsophalangeal joint. Although being small they are vitally important to normal weight bearing and foot mechanics. Normally, they transmit up to 50 % of body weight and during push-off can transmit loads greater than 300 %. Especially tibial sesamoid has to transmit great amount of body weight, that’s why is more inclined to injury. The sesamoids can be affected by variety of pathologies with distribution of stress fractures in 40 % and acute in 10 % of cases. Most of them are caused by repetitive stress or direct blows. Physical examination, radiographs, computer tomography, magnetic resonance imaging or scintigraphy help to diagnose fracture. Initial treatment is almost always conservative with orthopedic cast, specialized orthosis or partial weight bearing. In recalcitrant fractures surgical intervention is necessary. It consists of partial or complete sesamoidectomy and rarely internal fixation with screws or bone grafting. The most important for the success of surgical treatment is meticulous surgical technique. We can even more minimize complications with proper postoperative treatment.