A Less Common Anatomical Variant of Bilateral Multiple Lesser Metatarsal Sesamoids With Radiologic and Clinical Correlation

Accessory or supernumerary bones are bones that are not normally present in the body but can be found as an anatomical variant. While hallucal sesamoids are common, lesser metatarsal sesamoids are uncommon and often underreported. These ossicles develop through endochondral ossification and aid biomechanics by enhancing muscle function and reducing tendon friction. This report presents the first documented case of bilateral multiple lesser metatarsal sesamoids involving several metatarsophalangeal joints, supported by radiologic and clinical correlation. A 48-year-old woman presented with bilateral plantar foot pain, exacerbated by weight-bearing activities. Radiographs and computed tomography (CT) confirmed multiple lesser metatarsal sesamoids bilaterally, along with ossa peronea. Conservative management, including non-steroidal anti-inflammatory drugs, footwear modifications, and physical therapy, led to symptom improvement after six months. Lesser metatarsal sesamoids are usually asymptomatic but can contribute to metatarsalgia. Recognizing these ossicles as anatomical variants is essential to avoid misdiagnosis and unnecessary interventions. This case underscores their potential role in forefoot pain and diagnostic challenges.