Metatarsalgia is a general term for pain in the area of the metatarsophalangeal joints. Sesamoiditis is an uncommon cause of metatarsalgia. It is pain at the sesamoid bones beneath the head of the first metatarsal with inflammation or fracture. The diagnosis is usually clinical, with localized tenderness on palpation. Diagnosing the cause of metatarsalgia in patients without this classical sign is difficult. We present here such a case of a 37-year-old lady in whom sesamoiditis was diagnosed with technetium-99m ((99m)Tc)-methylene diphosphonate (MDP) single photon emission tomography-computed tomography (SPECT-CT).