We present the case of a fourty-two year old truck driver without a major trauma history who was diagnosed in our unit as having a stress fracture of the first metatarsophalangeal joint medial sesamoid bone. Conservative treatment consisting of 30 day immobilisation was our treatment choice. The result was very good and at six month follow-up the patient had no complains. We have searched for other opinions but there is a paucity of published literature on the injuries of the lesser toe sesamoids of the foot. The literature review revealed different types of treatment such as: conservative treatment, internal fixation of the sesamoid fracture (screw fixation), reduction of weight-bearing pressure on the affected sesamoid, ice massage or sesamoidectomy. Due to the fact that the different conclusions are based on very few cases, it is no possible to conclude about optimal treatment.