Sesamoiditis
Sesamoiditis is irritation of the two small bones beneath your big toe joint, causing pain under the ball of your foot that’s often worse with push-off during walking or running.
At Emerald Hill Podiatry, we assess what’s loading these bones excessively, then build a plan to offload them and ease inflammation, while ruling out the more serious possibility of a sesamoid fracture along the way.
What Are the Sesamoid Bones?
The sesamoid bones are two small, pea-sized bones embedded within a tendon on the underside of the big toe joint. Unlike most bones in the body, they aren’t connected directly to other bones. Instead, they sit within the flexor tendon, acting as a pulley system that helps the big toe push off the ground and absorbs a significant amount of load with every step.
Given their role, the sesamoids bear considerable weight-bearing force, particularly during activities that load the forefoot, such as walking, running, jumping, and pushing off.
When this load becomes excessive or repetitive beyond what the bones and surrounding tissue can tolerate, the area becomes inflamed and painful, a condition known as sesamoiditis
Why the Two Bones Under the Big Toe Become Inflamed
Sesamoiditis develops from repetitive overload of the sesamoid bones and the tissue surrounding them. Common contributing factors include:
- High-impact or repetitive forefoot activity, such as running, dancing, or sports involving frequent jumping or sprinting.
- High heels or unsupportive footwear, which shift excess weight forward onto the ball of the foot.
- A high-arched foot, which tends to place greater direct pressure through the sesamoid bones.
- Sudden increases in activity, particularly high-impact training, without adequate conditioning.
- Thin or inadequate fat padding under the ball of the foot, offering less cushioning to the sesamoids.
- Repetitive push-off movements, which place cumulative strain on the tendon and bones with each stride.
Symptoms of Sesamoiditis
- A dull, aching pain under the big toe joint that builds gradually, rather than appearing suddenly.
- Pain that worsens with weight-bearing activity, particularly push-off movements like walking, running, or standing on your toes.
- Tenderness when pressing directly on the ball of the foot beneath the big toe.
- Swelling or mild bruising in the affected area.
- Difficulty bending the big toe upward without discomfort.
- Pain that eases with rest and worsens again once activity resumes.
What’s a Sesamoid Fracture
Because the sesamoids bear significant repetitive load, they’re also vulnerable to stress fractures, a distinct injury from sesamoiditis that can be hard to tell apart without imaging. Fractures tend to cause more localised, sharper pain and don’t respond as readily to conservative care, so imaging is often used to confirm which condition you’re dealing with before finalising treatment.
When to See a Podiatrist
You should see a podiatrist if:
You have persistent pain under the ball of your foot near the big toe, especially with walking, running, or standing on your toes.
The pain hasn't improved despite rest and reduced activity.
You experienced a specific injury or traumatic event to the area, raising the possibility of a fracture.
Pain is sharp, localised, and significantly limiting your ability to walk normally.
Symptoms are recurring despite previous periods of rest.
Getting an accurate diagnosis early is what determines the right treatment path and avoids prolonging your recovery.
Get Your Forefoot Pain Properly Assessed
Ease the Pain with Our Treatments
Most cases respond well to conservative care focused on reducing load and allowing inflammation to settle.
Options include:
- Custom Orthotics — often with a dancer's pad or cushioned offloading feature, redistributing pressure away from the sesamoids
- Padding and Strapping — immediate cushioning and support during the early, more painful stages
- Activity Modification — temporarily scaling back high-impact activity to let inflamed tissue settle
- Shockwave Therapy (ESWT) — stimulates blood flow and supports healing for cases that haven't fully settled with offloading alone
- Rest and Ice Protocol — brings down inflammation in acutely painful early stages
What to Expect at Your Assessment
Your podiatrist reviews when your pain started, whether there was a specific injury, and your activity and footwear, then examines the area for tenderness, swelling, and joint movement, alongside a review of your training patterns. X-rays or MRI may be used to distinguish sesamoiditis from a fracture. From there, you’ll be walked through the treatment options suited to your case, with your plan adjusted as symptoms improve.
