This chapter provides detail description of lesser toe deformity and sesamoid pathology. Chapter has 35 well illustrated diagrams and pictures. Mallet toe, hammer toe, claw toe, MTP instability, Freiberg’s infraction, Bunionette deformity, sesamoids and accessory bones, osteonecrosis, sesamoiditis and Weil osteotomy are described in detail. One table is included to highlight Smillic classification for Frieberg infraction. 48 references are included at the end of the chapter to facilitate further reading.