Sesamoiditis

Sesamoiditis is an overuse injury that causes pain, swelling and discomfort at and beneath the big toe joint. It can affect anyone, though we often see it in runners, dancers and those participating in activities that put additional pressure onto the ball of the foot. Sesamoiditis doesn’t actually affect the big toe joint itself (though the pain definitely radiates there), but the two small pea-shaped and sized bones called the sesamoids that are located just beneath the joint – hence the name!

 

While your sesamoid bones aren’t directly connected to the big toe joint, they are embedded within a tendon that runs directly beneath your big toe (called the flexor hallucis brevis) where they support the tendon’s function. It is this tendon that also becomes inflamed and painful. 

 

Sesamoiditis causes & symptoms

Anything that results in repeated extra pressure on your forefoot and hence your sesamoids and the associated tendon can result in sesamoiditis. This includes:

 

  • Physical activities – like running, dancing, and any sport or activity where you spend more time on your forefoot or repeatedly pushing off the ground in sports where you stop and start frequently
  • Biomechanical factors – like your foot structure or function, the effects of tight/imbalanced muscles, and the like
  • Trauma – such as impact directly to/on the foot
  • Other factors – like continuing to wear running shoes after they’ve worn down and no longer support your feet

 

If you have sesamoiditis, you’ll likely experience pain around the big toe when walking, going up on your toes or bending your big toe upwards, like when you push off the ground at the start of running. The joint may appear red and swollen, and pain can come on gradually or suddenly.

 

Treating sesamoiditis

Remember, if you have (or suspect that you have) sesamoiditis, you must stop any activities that trigger your painful symptoms. This is because the problem can worsen as the pressure on the forefoot continues. Treating sesamoiditis has three key parts: 

 

 

  • Reducing any current painful symptoms 
  • Offloading the forces away from the sesamoids and the tendon so they can repair and recover
  • Put the right measures in place to help prevent the problem from recurring in the future 

 

 

It’s important to remember that if the cause of the sesamoiditis is biomechanical, that is, due to abnormal foot function that overloaded the sesamoids, then it’s important to address and correct these abnormalities or the injury may occur again in the future. We do this using a combination of a gait & biomechanical assessment, 3D-scanned custom foot orthotics, padding/strapping, ensuring you’re wearing the right footwear to help relieve pain, temporary activity modification, and following the RICE (rest, ice, compression and elevation) principles for those initial pains.

 

In some cases, your sesamoid bones may also fracture. In this case, you may need a boot to help completely offload your forefoot so the bones can repair.