Sesamoid pain secondary to a plantar neuroma

Two cases are presented in which the necessity of a plantar incision for removal of a fibular sesamoid led to the incidental finding of an undiagnosed plantar neuroma and bursal sac. The first case presented a hypertrophic fibular sesamoid fused to the plantar aspect of the first metatarsal head. The second case presented a dystrophic fibular sesamoid consistent with a healing fracture or avascular necrosis. Plantar neuromas are a known cause of pain in the forefoot. The authors review the literature concerning plantar neuromas and provide a discussion of their etiology, clinical findings, and surgical treatment. Attention is directed to the use of a plantar incision as a viable alternative to the dorsal approach for excision of a fibular sesamoid and associated soft tissue masses.