Big Toe Joint: Sesamoiditis

The 26 Review

  • What is Sesamoiditis Inflammation of the sesamoid bone(s) located under the big toe joint
  • Causes Repetitive pressure on balls of feet, ill-fitting footwear, trauma
  • Symptoms Aching, throbbing, pain when bearing weight, swelling, redness under the big toe joint
  • Diagnosis Physical examination, X-ray imaging, clinical experience
  • Treatment Offloading and orthotics, rest, activity modification, anti-inflammatory medication, steroid injections, physiotherapy, surgery

Take a deeper look

Sesamoiditis is a painful condition that arises from inflammation of a small bone(s) under the big toe joint. These bones, called sesamoids, are situated under the 1st metatarsal head and are critical for movement and walking. If you have a running job or any type of activity that requires you to run, walk, or stand for long periods of time, you may be at risk of developing this condition.

In severe cases, a sesamoid injury may require surgery. Because there are degrees and levels to this condition, having an appointment with your Podiatrist sooner rather than later can certainly help avoid the worsening of this issue.


When you put weight on your feet or bend your knees, a shock-absorbing pad underneath the big toe joint moves. This motion can irritate or inflame nearby tissues that have chronic inflammation. The most common sites for inflammation are where ligaments and tendons attach to these two bones.

Movement of any sort that requires physical effort, such as jogging, biking, hiking, jumping, or playing sports, can lead to this condition if your feet are not properly cared for beforehand. Those who have smaller, bonier feet with high arches are also more susceptible to this condition than others.

Sudden increases in activity have been known to be a factor in those who develop sesamoiditis. It is always important to have a solid warm-up and stretching routine before any strenuous activity, even simply going for a long walk or jogging.


Pain occurring when walking is one of the main symptoms of sesamoiditis, which can contribute to overcompensation pain in the legs and back as we try to avoid placing weight on the painful area. Trouble bending and straightening the big toe is also a very telling sign of this condition. Swelling, redness, and bruising may occur and are the more visible signs of sesamoiditis.


Diagnosing sesamoiditis starts with a physical examination of the foot. During the exam, your doctor will examine the feet to look for tenderness in the sesamoid bones. Your doctor may ask you to straighten and bend your toe to determine the extent of the injury while an X-ray is ordered.

The near-center sesamoid bone in many people (the medial sesamoid) is often not singular; rather than only having one section, it can sometimes have two. Therefore, if an X-ray reveals smooth edges for the parts of the bone (like on a bipartite medial sesamoid) and rough edges (often jagged) for a fractured sesamoid, a bone fracture can be diagnosed.

Your doctor may also want X-rays of the other foot to compare it to the X-ray of the foot with sesamoiditis to make a final diagnosis.

Treatment For Sesamoiditis

Treatment for sesamoiditis is typically nonsurgical, but surgery to remove the sesamoid bone may be required if pain persists or in cases of fracture. The first line of defense is to stop physical activities for a period of time and lessen the load off your feet/toes to promote healing.

Anti-inflammatories such as ibuprofen can help to alleviate the pain. Elevate your feet and rest them. If it helps, ice your feet, but don’t apply ice directly to the skin – use an ice pack or wrap the ice in a towel.

Wear shoes with flexible and soft-soled, low-heeled soles. Activities such as putting weight on the balls of the feet should be avoided.

Orthotics can also help alleviate pressure points, especially for those with high arches. Your doctor may prescribe injections of steroid medication for swelling, and if your symptoms do not subside after 4 to 6 weeks, you may need to wear a removable short-leg fracture brace.

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