This is the first report in the English literature discussing the arthroscopic approach in the management of the fibular sesamoid osteomyelitis. First metatarsophalangeal joint fibular sesamoidectomy was successfully performed using big toe arthroscopy. The morbidity of the open surgical sesamoidectomy may be minimized by the arthroscopic approach. The authors describe the surgical principles and the potential advantages of arthroscopic sesamoidectomy compared with the open approach.