Sesamoiditis: A Complete Guide

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It happens to the best of us. Even if we wear proper foot protection, we can still suffer from foot pain.

However, if the pain lingers on after you’ve spent a day off your feet resting, then you may have something more serious to consider.

pain under big toe

If you feel pain in the ball of your feet and/or pain under your big toe specifically, then you may have sesamoiditis.

Sesamoiditis is not something to fear. It is not a rare disease, even if it may sound that way. In fact, this condition is actually fairly easy to treat.

Let us take a look at what sesamoiditis is, what causes it to occur, and how to treat it below.

What is Sesamoiditis?

Most bones in the body are connected by your joints, but there are a few bones which do not connect to a joint—or any other bone in your body, for that matter.

Instead, they connect to your tendons or are embedded within your very muscles themselves. These bones are referred to as sesamoids.

These bones provide a smooth surface over which your tendons can slide, greatly increasing your tendons’ ability to transmit the force your muscles exert whenever you work them.

The largest sesamoid in your body is your kneecap, also referred to as your patella. There are also smaller sesamoid bones no bigger than the size of a corn kernel located on the bottom of your foot near your big toe.

These sesamoids assist with bearing the weight of your feet, and help elevate the bones of the big toe. Because they are embedded into the tendon that moves the big toe, they are also subject to any damages that tendon may undergo.

Sesamoiditis is an inflammation of your tendons that connect to your sesamoid bones due to strain or overuse.

While your patella is the largest sesamoid, sesamoiditis usually refers to the inflammation of the tendons attached to the small sesamoid bones in your feet, rather than in your knee.

Inflammation of the tendons connected to your patella is instead referred to as tendinitis. In a sense, sesamoiditis is a form of tendinitis.

According to the American Academy of Orthopedic Surgeons, sesamoiditis is most common in athletes, mainly baseball catchers, ballet dancers, and runners, though anyone who undergoes rigorous activity that involves the repetitive and excessive use of the balls of your feet may also be susceptible to this condition.

Symptoms of Sesamoiditis

Pain from sesamoiditis is centralized in the ball of the foot (which is the area between your toes and the arch of your foot), specifically under your big toe.

This is because the two sesamoid bones in your foot are located within the tendon that is responsible for moving this toe, and are thus subject to the extensive pressure and forces this tendon undergoes on a daily basis to help your big toe push your foot forward.

The pain may also spread outwards to the whole of the bottom of your foot. Sesamoiditis may also lead to swelling in your foot, bruising, and/or difficulty with bending or straightening out your big toe. It may also hurt you to move your big toe, or cause it to make a popping noise as you walk.

Keep in mind that these small sesamoid foot bones are also subject to fracturing, much like any other bone in your body. It can be difficult to tell the difference between a fracture and sesamoiditis, but this very crucial difference lies in how your pain builds up.

Pain will flare up almost immediately when you fracture the sesamoids in your foot. If you have sesamoiditis, on the other hand, the pain will build gradually, beginning with a dull pain that may come or go throughout your day to an intense throbbing that is much harder to ignore.

The pain may lead a person to begin limping or shifting their weight more to their other foot if that foot is not undergoing pain as well.

Of course, these methods will only make matters worse, and may cause you other types of foot pain if you ignore these symptoms and do not seek treatment.

Causes of Sesamoiditis

Sesamoiditis is usually caused by the overuse of the tendons connected to the sesamoid bones in your foot, resulting in the inflammation and pain in the ball of your foot you may be feeling.

This overuse of your tendons in itself is caused by a number of factors, some of which include:

sesamoid bone foot

Poor-Fitting Shoes

Shoes that do not fit you well, whether they are too tight or too loose, can cause a wealth of health problems related to all kinds of foot pain.

Specifically, high heels or other pointy-toed shoes that squish your toes into a restricted space are especially infamous for causing foot pain due to the repeated trauma the balls of your feet and your toes are put through as you walk or move about.

Ill-fitting athletic shoes can also cause sesamoiditis. If your shoes are too tight, your feet may be prone to the same pressures and trauma that high heels or pointy-toed shoes put on your feet.

If your shoes are too loose, however, the sesamoid bones of your feet may rub around too much as you move, resulting in irritation or inflammation of the tendon connected to them.

Participation in Particular Sports

While keeping active and playing sports is not something to discourage, overworking your feet by participating in high-impact sports can lead to foot pain, regardless of age or level of activity.

Specifically, athletes who participate in sports like running, ballet, baseball, basketball, and tennis run a higher risk of damaging their feet.

Overpronation and Supination

Foot pronation is the normal position your feet should fall into as you stand or walk. Your foot should not roll too far inward or outward as you move, or it can cause you a variety of painful problems.

Overpronation is when your feet roll too far downward or inward at the ankle. This condition can cause your feet to flatten out, which leaves them vulnerable to many aches and pains.

Sesamoiditis is just one of many conditions that overpronated feet may cause.

Supination (also known as underpronation) is when your feet do not roll inward enough after landing on the ground. This makes the outer foot areas absorb the shock this puts on your feet instead of the inner areas, which are far better equipped to handle the impact.

Your pinky toes and other outer toes will continuously bear this excess weight, eventually creating much higher arches in your feet.

These higher foot arches leave you with an especially increased risk for sesamoiditis, as well as numerous other complications and pains.


The pads of fat that reside in the balls of your feet become thinner as you age, making you far more liable to pain in these areas.

Other conditions that older people are more likely to have, including gout and/or osteoarthritis, may lead to sesamoiditis.

Osteoarthritis, in particular, weakens your bones, which make you more susceptible to tendon irritation or inflammation.

Sesamoiditis Treatment

To test if you do indeed have sesamoiditis, your doctor will check for tenderness in the balls of your feet, as well as in the sesamoid bones in your feet, by having you bend and straighten your toe to the best of your ability.

The toe’s flexibility and pain level as you move it will aid with the diagnosis. Your doctor may also try to bend your big toe upward to see if your pain intensifies.

Your doctor will also request X-rays of your forefoot to ensure their diagnosis. Because sesamoid bones are naturally smooth and not jagged, it will be very easy for your doctor to deduce if your pain is caused by sesamoiditis or a sesamoid bone fracture instead.

Your doctor will order an X-ray of both your feet to compare the bone structures between them as well.

pain in ball of foot and big toe

If your X-rays turn out normal, your doctor may then resort to having you get a bone scan, which is a special imaging test where you must get a small, harmless amount of radioactive dye in your foot to help diagnose any underlying problems.

These scans provide details that will sometimes not show up in X-rays. Your doctor may also suggest you get an ultrasound of your foot or an MRI scan instead.

Sesamoiditis is fairly easy to treat yourself. To alleviate the pain, you may choose to do any of the following:


Be sure to rest your feet often, propping them up to remove any pressure.

By reducing the activities that cause pain in the ball of your foot and big toe for a time, including your daily exercise routine, your feet will be able to heal properly.

It is also advised that you apply a wrapped ice pack to the afflicted area several times a day for ten minutes each, as the ice will alleviate your tendons’ inflammation.


Taking over-the-counter medications, such as ibuprofen or aspirin, can help to relieve pain and inflammation in your feet.

If the pain becomes too intense to ignore, or if your foot swells, your doctor may also suggest you get steroid injections to reduce inflammation in your tendons.


Wearing comfortable, well-fitted shoes with soft soles and low heels may also help ease your pain, as these will take pressure off your sesamoid bones. You may also choose to wear clogs or other stiff-soled shoes.

You can also use custom or generic brand shoe inserts (such as Dr. Scholls) to alleviate foot pain.

As you slowly return to your active lifestyle, wearing cushioned pads in your shoes may help to prevent another sesamoiditis incident.

In some cases, your doctor may ask you to tape your big toe down to stretch and relieve the pressure, which is a procedure known as plantar flexion.

Wearing a leg brace for four to six weeks may also be recommended.


If the above treatment methods do not work, or in especially severe cases of pain, your doctor may recommend you get surgery to remove the damaged sesamoid bone.

Here’s a video explaining more on sesamoiditis.

Do you have any tips on dealing with sesamoiditis?