A previously reported study2 of the roentgenograms of 1,000 feet showed that the division of the medial (tibial sesamoid) of the big toe was noted in 7.2 per cent, and that of the lateral (fibular) sesamoid, in 0.6 per cent. The sesamoids do not obtain their center of ossification before the age of about eight or ten years and are often not completely ossified until two or three years later. Two or more centers of ossification are sometimes present. It is reasonable to assume that in some feet these multiple centers of ossification may fail to coalesce, creating a so-called “congenital division” of the sesamoids, which persists through life. Whether this division of the sesamoids is a genuine congenital malformation, the result of an overlooked trauma in early childhood, or a growth disturbance fitting into the group of osteochondritides (as Freiberg-Köhler's disease of the metatarsal heads, Perthes' disease of the femoral head, etc.), or possibly a combination of all the above conditions still remains a moot question. Not infrequently, especially in legal cases, the question arises as to whether we are dealing with a fracture resulting from a recent injury, or with a pre-existing congenital division of the sesamoid. Although some observers claim that the edges of the fragments are smooth in congenitally divided sesamoids while they present a serrate-like appearance in cases of fracture, we feel that the roentgenographic picture is rather similar in both cases, and certainly cannot be relied upon for a definite differential diagnosis. Likewise, the clinical findings are frequently confusing. A congenitally divided sesamoid may become painful and tender following a strain or a trauma, while, on the other hand, a true fracture may cause comparatively little discomfort, especially if the patient is examined a few days after the injury. Therefore, a definite diagnosis of a fracture is often very difficult and often can be arrived at only with a fair amount of probability. The case here reported is considered an extreme rarity because of an unusual coincidence which made it possible to diagnose it as an undeniable fracture of the sesamoid. Report of Case.–A colored woman, 31 years old, was operated upon for mild bilateral hallux valgus, on Feb. 14, 1934 (removal of bony projection and reefing of medial capsule). The roentgenogram made before the operation (Fig. 1), and likewise the post-operative one, showed normally shaped sesamoids under the first metatarsal heads. On April 18, 1934, while walking downstairs the patient stubbed her left toes against a step and fell. The left foot was apparently in marked equinus with the toes forcefully brought into plantar flexion. The patient remained confined to bed because of considerable pain, and was first seen in the clinic on April 24, 1934. She avoided weight-bearing on the ball of the left big toe, and a slight puffiness was noted over this area. There were no ecchymoses.