Foot Condition Guide
Sesamoiditis Treatment
Sesamoiditis is an overuse injury involving inflammation around the sesamoid bones beneath the big toe joint — essentially, a very sore big toe joint.
Prolonged, high-impact forefoot loading causes compressive forces between the sesamoid and metatarsal head, leading to pain that can sideline you from the activities you love. Our podiatrists will identify the root cause and get you back on your feet.
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What is Sesamoiditis?
The sesamoid bones are two small, pea-shaped bones embedded within the tendons beneath the big toe joint. They act like pulleys, providing a smooth surface for the tendons to glide over and helping to absorb weight-bearing forces.
Sesamoiditis occurs when chronic, repeated stress causes compressive forces between the sesamoid and metatarsal head. This is further contributed to by tensile forces from vigorous, high-impact forefoot loading — resulting in inflammation and pain.
Activities like running, jumping, dancing, and even lunges or planks can aggravate the condition. If left untreated, it can progress to stress fractures or avascular necrosis of the sesamoid bones.
What Causes Sesamoiditis?
Several factors contribute to the development of sesamoiditis. Understanding these helps guide both treatment and prevention.
Foot Shape & Structure
High-arched (cavoid) feet tend to place greater pressure on the big toe joint and the sesamoid bones. Whether you have bipartite sesamoid bones (naturally split into two pieces) also affects your risk.
High-Impact Activities
Running, jumping, dancing, and sports that involve repetitive forefoot loading place significant stress on the sesamoid bones. The cumulative effect of these forces leads to inflammation over time.
Footwear
Football boots with long, hard cleats or studs directly under the big toe joint put excessive pressure on the sesamoids. Thin-soled or unsupportive shoes can have a similar effect.
Biomechanical Overload
Poor foot mechanics, excessive pronation, or compensatory movement patterns can concentrate force through the first metatarsophalangeal joint, overloading the sesamoid bones.
Sesamoiditis Symptoms
Patients generally present with an insidious onset of activity-related medial forefoot pain that eases on rest. Pain is exacerbated by weight bearing and upon dorsiflexion (bending upward) of the big toe joint.
- ✓Acute or severe pain during the propulsive phase of walking (pushing off)
- ✓Loading the outside of the foot to avoid weight bearing over the big toe joint
- ✓Restricted and painful range of motion at the big toe joint
- ✓Tenderness upon direct compression of the affected sesamoid
- ✓Reduced plantar flexion strength (pushing down with the big toe)
- ✓Pain that worsens with high-impact activities like running and jumping
- ✓Pain during lunges, planks, or activities that extend the big toe
How We Treat Sesamoiditis
Treatment focuses on three core aspects: load optimisation, capacity building, and education. The goal is to get you active and pain-free — not just resting and hoping.
Load Optimisation
Determining what loading is essential and what is potentially pathological. Force redistribution is achieved through:
- ✓Footwear modifications
- ✓Strapping and padding
- ✓Custom orthotics
- ✓Gait retraining
Capacity Building
Strengthening surrounding musculature to reduce focal compression on the sesamoid bones. Although a CAM boot will ease painful symptoms in the short term, unless biomechanics are addressed it is likely the condition will return. We keep you active and engaged with your injury management plan while progressively building strength.
Education
Pain science education empowers you to understand your condition and take an active role in recovery. We set clear short, medium, and long-term goals together, and explain every step of the treatment progression so you know exactly what's happening and why.
What To Do Right Now
If you suspect sesamoiditis, seek professional podiatric assessment promptly. Delaying treatment increases the risk of complications including stress fractures and avascular necrosis.
Seek a podiatric assessment as soon as possible
Apply topical NSAIDs (like Voltaren Gel) for pain relief
Modify activities to reduce forefoot loading
Choose supportive footwear that reduces pressure on the big toe joint
Avoid high-impact activities until you've been assessed
Common Myths Debunked
“Cortisone injections will fix it”
While cortisone can temporarily reduce inflammation, it doesn't address the underlying biomechanical overload. Without structural modifications, recurrence is likely. We focus on treating the cause, not just masking symptoms.
“A CAM boot is the best treatment”
CAM boots provide short-term relief by off-loading the foot, but they can cause muscular deconditioning and fail to prevent symptoms from returning during normal activity. They're a tool, not a solution.
“You have to give up high heels entirely”
Lifestyle limitations may negatively impact treatment compliance. Rather than eliminating high heels completely, we recommend transitioning to supportive footwear temporarily, then working toward gradual tolerance improvements.
Frequently Asked
Questions.
What does sesamoiditis feel like?
+Sesamoiditis typically presents as a gradual onset of pain under the big toe joint that worsens with activity and eases with rest. It can feel like a deep ache or a sharp pain when pushing off during walking or running. Many people describe it as feeling like there's a pebble under the ball of their foot.
How long does sesamoiditis take to heal?
+Recovery time varies depending on severity and how quickly treatment begins. With proper load optimisation, capacity building, and adherence to your treatment plan, many patients see significant improvement within 6-12 weeks. More severe cases may take longer, especially if there are stress fractures involved.
Can I still exercise with sesamoiditis?
+Yes, but you'll need to modify your activities. High-impact forefoot loading (running, jumping) should be reduced, but you can often continue with low-impact alternatives like swimming or cycling. We'll help you stay active while your sesamoids heal.
Do I need imaging for sesamoiditis?
+Not always. A thorough clinical examination by an experienced podiatrist is often sufficient for diagnosis. Imaging may be recommended if stress fractures or avascular necrosis are suspected, or if your symptoms aren't responding to treatment as expected.
Will I need orthotics for sesamoiditis?
+Custom orthotics are often a key part of treatment — they redistribute pressure away from the sesamoid bones and correct biomechanical factors contributing to the overload. However, they're part of a comprehensive plan that also includes strengthening and education.
Don't let sesamoiditis slow you down.
Book your consultation today and get a clear diagnosis and a treatment plan that works.
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