Sesamoid disorders are common causes of forefoot pain. Because of the significant mechanical stresses and anatomic variations involved, the sesamoid complex appears to be affected by numerous pathologic processes. These include acute fractures, stress fractures, nonunions, osteonecrosis, chondromalacia, and various inflammatory conditions labeled sesamoiditis. Treatment options include conservative management with orthotics and immobilization, as well as operative interventions that range from fracture/nonunion fixation to various approaches for sesamoidectomy. This article outlines the diagnosis and treatment of these entities and reviews the results of these treatments.