The understanding of the pathology and treatment of hallux sesamoid disorders has improved considerably over the last few decades. It is interesting to speculate what further improvements are on the horizon. Newer imaging methods and possibly an increased use of small joint arthroscopy may make it possible to better diagnose and treat conditions of these two small bones and to develop better biologic and artificial methods of surface replacement. In the meantime clinicians should only excise sesamoids if it is really essential.