If you’ve ever felt sharp pain beneath your big toe when walking, running, or pushing off the ground, you may have experienced sesamoiditis—a surprisingly common condition that affects the small but mighty sesamoid bones under the first metatarsal head. These tiny, pea-sized bones act like pulleys for the tendons in your foot, helping you push off with power and stability every time you take a step.

When they become irritated, inflamed, or injured, the pain can be sharp, persistent, and surprisingly limiting.

Here’s everything you need to know about sesamoiditis—including what causes it, who is most at risk, and how podiatrists treat it effectively.

What Are the Sesamoid Bones?

Unlike most bones in the body that connect to others, sesamoid bones are embedded within a tendon. In the foot, there are two sesamoids located beneath the big toe joint (the first metatarsal head):

• Tibial sesamoid (inner side)

• Fibular sesamoid (outer side)

These bones:

• Absorb impact

• Assist with weight-bearing

• Act as a lever to help the big toe push off

• Protect tendons from stress and friction

When these bones or their surrounding tendons become irritated, the result is sesamoiditis.

What Is Sesamoiditis?

Sesamoiditis is inflammation of the tendons around the sesamoid bones, typically caused by repetitive stress. It is considered an overuse injury and can develop gradually or suddenly, depending on activity level.

Common Causes of Sesamoiditis

Sesamoiditis often results from:

✔ Repetitive pressure on the ball of the foot

Running, sprinting, jumping, and dancing place continuous stress on the sesamoids.

✔ High-impact or forefoot-loading activities

Track athletes, dancers, gymnasts, and basketball players are especially prone.

✔ Sudden increase in training intensity

More miles, more hours, or new activities can overload the sesamoids.

✔ High heels or thin-soled shoes

These shift weight forward, putting excessive pressure beneath the big toe.

✔ Foot structure

Certain foot types increase risk:

• High arches

• Plantarflexed first ray

• Bunions

• Longer first metatarsal

✔ Trauma

A sudden blow or hyperextension of the big toe can injure the sesamoid complex.

Symptoms of Sesamoiditis

Signs you may be dealing with sesamoiditis include:

• Pain beneath the big toe joint

• Increased pain when pushing off, running, or walking uphill

• Tenderness to touch on the ball of the foot

• Swelling or bruising

• Difficulty bending or straightening the big toe

• Pain when wearing thin-soled or high-heeled shoes

• A sensation of “walking on a pebble”

Symptoms often start gradually and worsen without treatment.

Is It Sesamoiditis or a Sesamoid Fracture?

This distinction matters, and podiatrists diagnose it using:

• X-rays

• Physical exam

• MRI or CT (if the injury is unclear)

A sesamoid fracture results from trauma and requires a different treatment approach. Sesamoiditis is due to inflammation and repetitive stress.

How Podiatrists Treat Sesamoiditis

The good news: sesamoiditis is highly treatable, especially when diagnosed early. At Restore Foot & Ankle Specialists, we offer comprehensive, personalized treatment to reduce pain and protect your sesamoids long-term.

1. Offloading the Sesamoids

We reduce pressure beneath the big toe using:

• Custom orthotics

• Dancer’s pads

• Sesamoid cutouts

• Shoe modifications

These redistribute weight and help the inflamed tissues heal.

2. Activity Modification

Temporarily reducing high-impact activity prevents ongoing irritation.

3. Footwear Changes

We recommend:

• Cushioned sneakers

• Stiff-soled shoes

• Avoiding high heels and flexible, thin-soled flats

4. Anti-Inflammatory Treatment

• Ice

• Oral NSAIDs (if safe for the patient)

• Topical anti-inflammatory medication

5. Immobilization

In moderate to severe cases, a CAM boot or stiff surgical shoe gives the sesamoids time to recover.

6. Laser Therapy (if offered in the office)

Laser therapy can help reduce inflammation and pain deeper in the joint.

7. Physical Therapy

Focused exercises to strengthen foot muscles and improve biomechanics.

8. Injection Therapy

In select cases, corticosteroid injections may be used to reduce persistent inflammation.

9. Surgery (rare)

Only considered when all conservative treatments fail or in cases of chronic non-union fractures.

How Restore Foot & Ankle Specialists Can Help

At Restore Foot & Ankle Specialists, we see sesamoid injuries frequently—and we offer multiple tailored treatment options right in our office.

Our team provides:

✔ Same-day diagnosis with on-site digital X-rays
✔ Custom orthotics designed to offload the sesamoids
✔ Protective padding and immobilization options
✔ Cutting-edge treatments to reduce inflammation and speed healing
✔ Guided return-to-activity plans for athletes and active individuals

We don’t just treat the pain—we address the underlying biomechanics that caused it to prevent recurrence.

If you’re feeling pain in the ball of your foot or beneath your big toe, don’t wait until it becomes severe. Early treatment makes recovery significantly faster and more successful.

The Bottom Line

Sesamoiditis may involve small bones, but it can cause big pain and major limitations. With proper diagnosis and podiatric care, most patients experience full relief and a return to normal activity.

If you suspect sesamoiditis, schedule an appointment with Restore Foot & Ankle Specialists to get the personalized care and relief you deserve. Contact our office today with Dr. Gireesh Reddy or Dr. Sirisha Pokala by calling (469) 573-3427 or by booking an appointment online.