Introduction: A diabetic patient presented with a recurrent big toe ulcer. It had healed several times, but kept opening despite appropriate offloading.
Methods: Radiographs were taken which displayed an accessory sesamoid bone at the hallux under the interphalangeal joint. MRI was peformed to rule out osteomyelitis. The sesamoid was removed and the ulcer healed.
Results: The hallux ulcer was caused by the accessory sesamoid. 3 weeks after removing it, the ulcer that had been on and off for 3 years, healed without recurrence.
Discussion: Hallux ulcers often have a biomechanical or anatomical reason for occurring. In this case, the accessory bone was adding extra pressure from the inside to the wound area. This is why the patient would heal if she was taken completely off of her foot or put in a total contact cast, but she would not stay healed when put back into an offloading insert.
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