Rare, but potentially debilitating, injuries in the athlete may originate from trauma to the sesamoid bones of the great toe. Controlled studies comparing conservative versus surgical treatment outcomes are lacking owing to the limited number of suspected and proven cases of sesamoid stress fracture or sesamoiditis, a nondescript, painful condition involving the sesamoid. Thus, familiarity with the anatomy and congenital variations of the sesamoid is necessary to identify possible pathology in this area. Existing studies of surgical and nonsurgical treatment of athletes with great toe sesamoid injuries are reviewed.