Sesamoiditis

Sesamoiditis is an overuse injury that causes pain, swelling and discomfort at and beneath the big toe joint. It can affect anyone, though we often see it in runners, dancers and those participating in activities that put additional pressure onto the ball of the foot. Sesamoiditis doesn’t actually affect the big toe joint itself (though the pain is definitely felt there), but instead affects the two small pea-shaped and sized bones called the sesamoids that are located just beneath the big toe at the ball of the foot. 

While your sesamoid bones aren’t directly connected to the big toe joint, they are embedded within a tendon that runs directly beneath your big toe (called the flexor hallucis brevis) where they support the tendon’s function. It is this tendon that also becomes inflamed, producing painful symptoms. 

The symptoms of sesamoiditis will depend on the severity of the injury as ‘sesamoiditis’ can encompass everything from mildly irritating the tendon to fracturing a sesamoid bone. Symptoms may include:

• Pain that may start off as a mild ache and quickly progress to an intense throbbing, or severe pain where pressure is applied to the big toe joint
• Difficulty walking on the affected foot - many try to walk on the outside of the foot to avoid putting pressure on the sesamoids
• Swelling or redness around the big toe joint
• Pain and difficulty bending the big toe upwards (dorsiflexing)
• Bruising beneath the big toe joint

Due to the location and function of the sesamoid bones, they are subjected to large amounts of pressure and forces every time the big toe is used to push the foot forward - including with every step you take. Anything that results in repeated extra pressure on your forefoot and hence your sesamoids and the associated tendon can result in sesamoiditis. This includes:

• Physical activities - like running, dancing, and any sport or activity where you spend more time on your forefoot or repeatedly pushing off the ground in sports where you stop and start frequently
• Biomechanical factors - like your foot structure or function, the effects of tight/imbalanced muscles, and the like
• Trauma - such as impact directly to/on the foot
• Other factors - like continuing to wear running shoes after they’ve worn down and no longer support your feet

Those with prominent foot bones, higher arched feet, markedly flat feet or those who tend to run on the ball of their foot also tend to have a higher risk of developing sesamoiditis.

To ease the symptoms of sesamoiditis and start your path to healing and repair, you can try:

• Avoiding activities that overload your forefoot and cause you pain
• Avoid high heels, as these add pressure to your forefoot. Instead, opt for comfortable low-heeled shoes, ideally with good arch support
• Icing the big toe for 10 minutes through a towel or cloth, three to four times a day. This helps reduce swelling, and hence your painful symptoms
• Using non-steroidal anti-inflammatories (NSAIDs) to help relieve pain and swelling
• Applying felt padding to your forefoot inside your shoe, and cutting out the area from beneath the ball of your foot at your big toe only, forwards to the end of the toe. This is something you may need your podiatrist to help with for its technical placement, otherwise it can make your pain worse if the padding presses on the sesamoids or the injured tendon.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with sesamoiditis, and utilise a range of evidence-based treatment methods to help you get the best outcome.

Every appointment starts with a comprehensive assessment to understand the biomechanics of your feet and legs, and all of the factors that are playing a role in overloading your big toe and creating this problem. We’ll then create a tailored treatment plan based on your results that focuses on helping to heal and repair the damaged bones or tissues, while allowing you to stay as active as possible so you can enjoy the things you love. We may use:

• Orthotics (insoles): using the results of your assessment, our podiatrists can prescribe custom foot orthotics that will work to effectively offload the painful sesamoids, enabling you to continue to walk without pain. Most people experience immediate relief once the sesamoids are offloaded in this way, and are able to go about their regular day while the inflamed joint begins to heal and repair.
• Footwear recommendations: your footwear plays a vital role in supporting your foot health and comfort. This is why we make personalised footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions.
• Temporary padding or strapping: depending on the nature and severity of your injury, we may apply some strapping to the big toe, or use some temporary deflective padding inside of your shoe to help you get relief and support the healing and repair process.
• Temporary boot or walker: in the case of persistent severe sesamoiditis or a significant stress fracture of the sesamoids, the use of a short-term walker with features like a rocker sole (or other) may be required for a few weeks. This will help optimise your healing and reduce your recovery time.

The above measures are the primary recommendations for sesamoiditis and for most of our patients, work brilliantly to get them fully recovered. In rare cases where you do not respond to standard treatment, we will discuss further options like a referral for a steroid injection, or for surgery.