What is Sesamoiditis?

Sesamoiditis, a form of tendinitis, is pain around the sesamoid bones that lie beneath the head of the big toe (first metatarsal). There are two very small sesamoid bones in the underside of the forefoot near the big toe. One is on the outer side of the foot with the other located closer to the middle of the foot.

While these sesamoids are only about the size of a pencil eraser, they can break just like any other bone. When the tendons around them become inflamed and irritated, sesamoiditis occurs.

Sesamoids are a special type of bone that are not connected to any other bone at a joint. They are connected to tendons instead of other bones, or are embedded in muscle. The largest sesamoid bone is the patella, or kneecap.

Acting like pulleys, sesamoids provide a smooth surface for the tendons to slide over, allowing the tendons to transmit muscle force. The sesamoids near the big toe also help with weightbearing and elevating the bones of the big toe.

What Causes Sesamoiditis?

Sesamoids can fracture due to a traumatic injury. Stress fractures may also develop from overuse. Injury or overuse can also cause the tendons around the sesamoids to become irritated or inflamed.

Sesamoiditis risk factors include:

  • Certain professions, including dancers, joggers and runners, baseball catchers and many other professional sports
  • High-arched feet
  • Bunions
What Are Symptoms of Sesamoiditis?

Pain focused in the ball of the foot and big toe is the most common symptom of sesamoiditis. The pain may develop gradually; however, with a fracture, the pain will be immediate. Other sesamoiditis symptoms include:

  • Swelling and bruising, though these may not be present in all cases
  • Inflammation with mild warmth, redness or both present
  • Difficulty and pain when bending and straightening the big toe
  • Worsening pain when walking
  • Worsening pain when wearing flexible, thin-soled or high-heeled shoes
How Is Sesamoiditis Diagnosed?

A physical examination is performed to look for tenderness at the sesamoid bones. The bone may be manipulated or the big toe bent and straightened to check for intensifying pain. Imaging tests of the forefoot, such as X-rays, are usually ordered for a proper diagnosis. If the X-rays look normal, a bone scan may be ordered. Additional tests may include blood tests to rule out gout or inflammatory arthritis.

How Is Sesamoiditis Treated?

Sesamoiditis treatment is most often nonsurgical. In rare cases, if these conservative measures fail, surgery may be recommended to remove the sesamoid bone. This surgery is controversial and should be discussed at length with a foot and ankle surgeon.

Traditional treatment measures include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain
  • Resting and ice pack application on the sole of the affected foot
  • Switching to stiff- or soft-soled, low-heeled shoes
  • Shoe cushioning pad made of dense foam rubber to relieve stress (usually J-shaped); may be made of felt
  • Stopping the activity causing pain, though this may be impossible or harder to do if the activity is a profession
  • Gradual return to activity, while avoiding activities that put weight on the balls of the feet
  • Taping the big toe slightly downward (plantar flexion) to limit joint movement
  • Steroid injection to reduce swelling (if deemed appropriate by a physician)
  • Wearing a removable short leg fracture brace for four to six weeks (if symptoms do not abate)
  • Wearing a cast (in cases of fracture)

Healing of the sesamoid bones is usually slow and may take up to six months. Though the slowness of the healing process can be frustrating, the symptoms typically resolve.

If you are experiencing symptoms of sesamoiditis, contact us today to speak with one of our specialists or request an appointment.

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      Meet Our Doctors

      The physicians of Essex Union Podiatry are experienced and dedicated professionals trained in various subspecialties of podiatry care. Click on the pictures below to learn more about our doctors.

      Jason P. Galante, DPM,

      Jason Galante, DPM, AASPS

      Nancy A. Kaplan, DPM, MBA, AACHE, FACFAS


      Sarah E. Haller, DPM, AACFAS