Sesamoiditis – Pain Below the Big Toe

The sesamoids are two tiny bones located beneath the large joint of the big toe. Sesamoiditis is inflammation of these tiny bones. It is characterised by pain in the region of the ball of the foot just below the big toe joint. Sports that involve loading of the forefoot such as running and tennis can cause sesamoiditis, although day-to-day fitness walking or dancing may also be causative. Symptoms may be acute or come on over time, particularly at the commencement or changing of a training regimen. In some instances these bones may appear to be fractured on x-ray when in fact the bones display a naturally occurring split or separation (partite). This situation can aggravate symptoms but should not cause any problems in the absence of inflammation or pain. Tight hamstring and calf muscles may also play a role, as may certain types of footwear such as rugby or soccer sprigs.

How Is Sesamoiditis Treated?

Sesamoiditis is a condition that generally responds well to conservative treatment if treated early. This may include:

Training modification;

Ceasing or modifying training to decrease excessive load over the effected region;

Correction of abnormal foot function;

Orthoses are designed to allow the foot to function around its normal position and deflect pressure from the site. This assists in allowing the sesamoids to recover initially and then to prevent future recurrence of the injury;


Stretching tight muscles to decrease forefoot loading and stress over the affected region is important;

Anti-inflammatory medications;

In acute injuries these may be indicated in the early stages of treatment to help reduce any inflammation present;

Casting or immobilisation;

If a fracture is present there may be a necessity to cast or immobilise the site, however, this can often be avoided with good compliance with all other measures.


In very severe or chronic cases.

Resolution may take some time and there is a risk of reoccurrence, however, following your podiatrist’s advice and addressing the causative factors should help to have you back on your feet.