# Sesamoiditis > Sesamoiditis is pain under the big toe joint, from irritation of two small bones there, usually through overuse. Easing the load with activity changes, wide low-heeled shoes and padding or insoles is the usual first step. A podiatrist can assess it and rule out a fracture. Guide in [Toes and forefoot](https://footanklelowerlimb.com.au/learn/topics/toes-and-forefoot), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/sesamoiditis Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **It's pain under the big toe joint.** Two small bones there, called sesamoids, get irritated, usually from too much load. - **Load and footwear matter.** Sudden increases in activity, high heels and unsupportive shoes are all linked with it. - **Easing the load is the first step.** Activity changes, wide low-heeled shoes, and padding or insoles from a podiatrist are the usual starting point. - **Get it assessed.** A fracture and other problems can feel the same, so it's best not to self-diagnose. - **It can come back,** and some people need more than first-line care. ## 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 them [1]. These bones sit within a tendon at the base of the long bone that connects to your big toe, and help pull the toe downwards [2]. It's an umbrella term, used when there's no specific cause such as a fracture or a loss of blood supply to the bone [3]. It's often a diagnosis reached after other problems are ruled out, and it's typically seen in younger women [4]. It's common in young, active people [5], and is frequently seen in athletes [6]. ## What causes sesamoiditis, and who gets it? The sesamoids take a large amount of force when you walk and run [2]. Most sesamoid injuries build up from overuse, though a direct knock or the big toe being forced upwards can cause a sudden one [7]. Running, jumping, dance and ball sports are linked with it [6]. So are sudden increases in activity, regular high heels and unsupportive footwear [8], a high-arched foot [4], 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 toe [6]. 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 foot [4][8]. A podiatrist usually diagnoses it from your history and an examination, which includes pressing on the area and moving your big toe joint [9][7]. Scans and x-rays aren't always needed [9], but an x-ray or MRI may be used if a fracture is a worry or the picture is unclear [4][10]. 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 joint [11]. 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 cases [4]. Most symptoms settle with a change in footwear, orthotics (shoe inserts) and activity changes, including rest and stretching [9]. 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 sesamoids [4]. 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. > [!tip] Try this > While it settles, swap high heels and thin, unsupportive sandals for wide, low-heeled shoes. Notice when the pain comes on and what eases it, and tell your podiatrist. Offloading insoles seem to give the most consistent short-term relief, though pain can return, and how well these treatments work isn't certain yet [6]. ## 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 possible [1]. 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 back [6]. It isn't suitable if a sesamoid fracture or loss of blood supply to the bone is present or hasn't been ruled out [4]. 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 walk [6]. A stress fracture of a sesamoid can be slow to heal, so it's managed more actively [10]. ## How long does it take to settle, and how do I stop it coming back? Most symptoms usually settle with time and non-surgical care [9]. 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 care [6]. 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. ## When to see a podiatrist See your GP or a podiatrist the same day if: - you can't put weight on your foot after an injury [12]; - your foot is red, hot or swollen [12]; - you heard a snap, grinding or popping noise when you hurt it, or you feel faint, dizzy or sick from the pain [13]; - you have diabetes and your foot has a wound, sore, blister, colour change, or any redness, heat or swelling [12][13]. If you think you might have broken your foot, don't try to treat it yourself [13]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. See your GP soon if you have severe pain that doesn't ease, or night pain that stops you sleeping, especially with a fever or weight loss [12]. See your GP if ball-of-foot pain hasn't improved after 2 weeks of home care, stops you doing normal activities, or comes with tingling or loss of feeling, or if you have diabetes and any foot pain [13]. See a podiatrist or your GP if nothing has changed after six to twelve weeks, or pain increases markedly after exercise [8]. Because a fracture and other problems can look similar, it's best to have ball-of-foot pain assessed [4]. ## Common questions ### Can I keep running or exercising with sesamoiditis? It usually helps to cut back on activities that load the ball of your big toe, such as running, jumping and repeated tiptoe work, while it settles. Stop any exercise if pain increases or you feel unwell. As it improves, build back gradually rather than returning at full load, and ask a podiatrist to help you plan it. ### What shoes are best for sesamoiditis? Wide shoes with a low heel are the usual advice, because a lower heel reduces pressure on the sesamoids. It's worth avoiding regular high heels and unsupportive shoes or sandals while the pain settles. No particular brand is needed. A podiatrist can check your footwear and whether padding or an offloading insole would help. ### Do I need an X-ray or MRI for sesamoiditis? Often not: a podiatrist can usually diagnose it from your history and an examination. An x-ray or MRI may be suggested if a fracture is possible, the picture is unclear, or the pain isn't settling. Imaging also matters before any injection, so that a fracture or loss of blood supply to the bone has been ruled out. ### Can I take anti-inflammatory painkillers for sesamoiditis? Pain relief, including anti-inflammatories, is sometimes part of care, but what suits one person may not suit another. Check with your GP or pharmacist about which pain relief is safe for you before using any. Pain relief doesn't replace easing the load on the toe joint, which is the main first step. ## Further reading - [Sesamoiditis on Clindice](https://clindice.com/sesamoiditis) - [Foot pain - Leeds Community Healthcare](https://leedscommunityhealthcare.nhs.uk/our-services-a-z/podiatry/foot-pain/), NHS - [Pain Under Your Big Toe? It Might Be Sesamoiditis](https://my.clevelandclinic.org/health/diseases/21671-sesamoiditis), Cleveland Clinic - [Sesamoiditis and Sesamoid Fracture - OrthoInfo - AAOS](https://www.orthoinfo.org/diseases--conditions/sesamoiditis/), OrthoInfo (American Academy of Orthopaedic Surgeons) - [Sesamoid Injuries in the Foot – Sesamoiditis Foot | Foot Health Facts - Foot Health Facts](https://www.foothealthfacts.org/conditions/sesamoid-injuries-in-the-foot?lang=en-US), FootHealthFacts (American College of Foot and Ankle Surgeons) - [Sesamoiditis](https://www.kentcht.nhs.uk/leaflet/sesamoiditis-2/), NHS ## Sources 1. The development of recommendations for the assessment and management of sesamoiditis by podiatrists: A Delphi and content validity study · Stewart S, Kaur P, Tehan P et al. · Journal of Foot and Ankle Research · 2024. https://doi.org/10.1002/jfa2.12025 2. Sesamoiditis · NHS. https://msk-bexley.nhs.uk/Portals/0/adam/Accordions/LGRLlex5vkOvW_mmbVUDeA/Content/MSK%20Sesamoiditis.pdf 3. Sesamoiditis · Kent Community Health NHS Foundation Trust · 2025. https://www.kentcht.nhs.uk/leaflet/sesamoiditis-2/ 4. Painful sesamoid of the great toe · Sims AL, Kurup HV · World Journal of Orthopedics · 2014. https://doi.org/10.5312/wjo.v5.i2.146 5. Sesamoiditis · NHS. https://www.ncic.nhs.uk/services/podiatry/sesamoiditis 6. Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis · Biz C, Maccarone MC, Bonso V et al. · Medicina (Kaunas, Lithuania) · 2025. https://doi.org/10.3390/medicina61071215 7. Forefoot Injuries in Athletes: Integration of the Movement System · Carroll LA, Paulseth S, Martin RL · International Journal of Sports Physical Therapy · 2022. https://doi.org/10.26603/001c.30021 8. Pain in your big toe - sesamoiditis · Bradford District Care NHS Foundation Trust · 2025. https://www.bdct.nhs.uk/pain-in-your-big-toe-sesamoiditis/ 9. Sesamoiditis · NHS. https://msk-bexley.nhs.uk/conditions/foot-and-ankle-pain/sesamoiditis 10. Stress fractures of the foot - current evidence on management · Paavana T, Rammohan R, Hariharan K · Journal of Clinical Orthopaedics and Trauma · 2024. https://doi.org/10.1016/j.jcot.2024.102381 11. High-Resolution Ultrasound of the Forefoot and Common Pathologies · Chen X, Zhou G, Xue H et al. · Diagnostics (Basel, Switzerland) · 2022. https://doi.org/10.3390/diagnostics12071541 12. Foot and Heel Problems · South & West. https://southwest.devonformularyguidance.nhs.uk/referral-guidance/western-locality/musculoskeletal/foot-and-heel-problems 13. Pain in the ball of the foot · NHS. https://www.nhs.uk/symptoms/foot-pain/pain-in-the-ball-of-the-foot/ --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.