Sesamoid pain can result from repetitive stress, arthrosis, osteochondritis dissecans, and fracture. The medial or tibial sesamoid typically bears more stress than the lateral or fibular sesamoid and is more likely to be injured. This pain often leads to significant changes in patient function and gait. Conservative treatment often consists of initial rest and protected weight bearing of the injured extremity with an orthotic or a short course of immobilization. After failure of conservative therapy, surgical treatment of chronic sesamoiditis typically results in bone grafting, sesamoid shaving, and partial or complete sesamoid excision. Isolated tibial sesamoidectomy is a surgical procedure with good pain relief and return to activity with minimal associated malalignment when properly evaluated and treated.