Sesamoiditis

What is sesamoiditis, and how common is it?

Sesamoiditis is pain and inflammation (irritation and swelling) in the two small, pea-shaped sesamoid bones under your big toe joint, or in the soft tissue around them¹. These bones sit within a tendon at the base of the long bone that connects to your big toe, and help pull the toe downwards².

It's an umbrella term, used when there's no specific cause such as a fracture or a loss of blood supply to the bone³. It's often a diagnosis reached after other problems are ruled out, and it's typically seen in younger women⁴. It's common in young, active people⁵, and is frequently seen in athletes⁶.

What causes sesamoiditis, and who gets it?

The sesamoids take a large amount of force when you walk and run². Most sesamoid injuries build up from overuse, though a direct knock or the big toe being forced upwards can cause a sudden one⁷.

Running, jumping, dance and ball sports are linked with it⁶. So are sudden increases in activity, regular high heels and unsupportive footwear⁸, a high-arched foot⁴, and excessive pronation (the foot rolling inwards)⁶. These are linked factors rather than proven causes. If you play sport or dance, mention your training load when you're assessed.

What does it feel like, and how is it diagnosed?

Sesamoiditis usually causes pain under the big toe joint, or a more spread-out ache across the sole of the big toe⁶. It tends to be worse with movement and weight-bearing, especially when you push off or rise onto your tiptoes, and it eases when you take weight off the foot⁴⁸.

A podiatrist usually diagnoses it from your history and an examination, which includes pressing on the area and moving your big toe joint⁹⁷. Scans and x-rays aren't always needed⁹, but an x-ray or MRI may be used if a fracture is a worry or the picture is unclear⁴¹⁰. Similar pain can come from a fracture, a sesamoid that's naturally in two parts (which can look like a fracture)¹¹, or gout, bunions or a stiff big toe joint¹¹. That's why an assessment is better than guessing.

What can I do first, and what will a podiatrist suggest?

Easing the load on the sesamoids is the usual first step, and non-surgical care comes first in most cases⁴. Most symptoms settle with a change in footwear, orthotics (shoe inserts) and activity changes, including rest and stretching⁹.

At home, cut back on running, jumping and repeated tiptoe work while it settles, and stop any activity if pain increases or you feel unwell. Wide shoes with a lower heel reduce pressure on the sesamoids⁴. A podiatrist can add an offloading insole or padding, such as a metatarsal pad (a small pad that takes pressure off the sesamoid)¹⁰. Ask a GP or pharmacist which pain relief is safe for you before using anti-inflammatories.

Offloading insoles seem to give the most consistent short-term relief, though pain can return, and how well these treatments work isn't certain yet⁶.

What if that isn't enough?

If pain persists despite sensible offloading and footwear changes, ask your podiatrist or GP about imaging and whether a referral is right for you. Referral is considered if you aren't responding to non-surgical care within a reasonable time, or a cause elsewhere in the body is possible¹.

An injection of corticosteroid (a strong anti-inflammatory), guided by imaging, can be considered if symptoms persist. It gives short-term relief, but pain can come back⁶. It isn't suitable if a sesamoid fracture or loss of blood supply to the bone is present or hasn't been ruled out⁴.

Surgery is a later option, kept for carefully selected people after thorough non-surgical care. Its risks include the big toe drifting sideways (hallux valgus), weaker push-off and a change in the way you walk⁶. A stress fracture of a sesamoid can be slow to heal, so it's managed more actively¹⁰.

How long does it take to settle, and how do I stop it coming back?

Most symptoms usually settle with time and non-surgical care⁹. How long that takes varies, and a firm timeframe isn't clear yet. Younger age, a higher body mass index and a sesamoid in two parts have been linked with a poorer response to non-surgical care⁶.

It can come back, and no particular strategy has been shown to prevent that. Sensible habits are still worth a try: build running, jumping, dance or standing time up gradually, keep to low-heeled, supportive shoes, and ask a podiatrist about offloading insoles if the pain keeps returning. If you play sport, ask your clinician about a graded return rather than going straight back to full training.