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Pain involving the hallux sesamoid bone is commonly referred to as sesamoiditis. This condition is often seen in athletes, representing 2.2% of foot injuries in collegiate athletes.1 A study investigating 683 young athletes presenting to a sports medicine clinic reported that the most common diagnosis for pain localised to the hallux sesamoids was sesamoiditis.2 While a recognised injury, the management strategies reported in the literature are not consistent and include non-surgical management with mixed outcomes3 to surgical excision.4 One explanation for the variability in treatment outcomes is the non-specific diagnostic criteria for sesamoiditis. Injuries to the hallux sesamoid complex may include a variety of plantar first metatarsophalangeal (MTP) conditions—including ‘turf toe’ (if a traumatic mechanism), MTP synovitis or osteoarthritis, bipartite pseudoarthrosis pain, mild chondrosis and subchondral oedema between the sesamoid and first metatarsal head, or bone stress injury (BSI). In this editorial, we present the rationale for reframing the diagnostic framework for sesamoiditis to include a high suspicion for sesamoid BSI.