Noticing pain underneath the big toe that intensifies during weight-bearing activity? It could be a condition called “sesamoiditis”. 

Sesamoiditis is an overuse injury as it affects the sesamoid bones, located under the big toe joint in the foot. Read on to learn more about the causes of this condition and how it’s treated.

What is Sesamoiditis

Sesamoiditis is an inflammatory condition that affects the sesamoid bones, located under the big toe joint in the foot. These small, pea-shaped bones are embedded in the tendons and are crucial for weight-bearing and toe movement. 

Sesamoiditis typically arises from repetitive stress or overuse, common in activities that exert pressure on the balls of the feet, such as running, ballet, and various sports. It can also occur due to a direct injury, like a fracture of a sesamoid bone.

Symptoms of Sesamoiditis

The main symptom of sesamoiditis is pain under the big toe, which intensifies during weight-bearing activities and may be accompanied by swelling and tenderness. This pain often develops gradually and worsens when engaging in certain activities or wearing specific shoes. Diagnosis involves a physical examination, a review of the patient's history, and imaging tests like X-rays or MRIs to distinguish it from other conditions and assess the inflammation.

  • The most noticeable symptom is a persistent, often sharp pain beneath the big toe joint. This pain is usually concentrated in the ball of the foot.
  • Some individuals may experience swelling and bruising around the affected area.
  • The pain tends to worsen when pressure is applied to the sesamoids, such as when walking, running, or jumping.
  • The inflammation can make it painful to move or bend the big toe, affecting walking and other activities.
  • The pain typically increases with physical activities, especially those that place more force on the ball of the foot and often improves with rest.
  • There may be tenderness when touching the area directly beneath the big toe joint.

How to Treat Sesamoiditis

Treatment primarily focuses on non-invasive methods: rest, applying ice to the affected area, and using nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. Additional measures include padding or cushioning in shoes to relieve pressure from the sesamoid bones, orthotic devices to correct biomechanical imbalances, and physical therapy to strengthen surrounding muscles and improve foot mechanics. Activity modification is also crucial to avoid exacerbating the condition. Recovery times vary depending on the severity and treatment efficacy, emphasizing the importance of allowing adequate healing time and gradually resuming activities to prevent recurrence.

  • Rest and Activity Modification: It's crucial to avoid activities that exacerbate the pain, like running or ballet. Giving the foot time to heal is important in reducing inflammation.
  • Ice Therapy: Applying ice to the affected area can help reduce swelling and alleviate pain. This should be done several times a day, especially after any activity that puts stress on the foot.
  • Pain Relief Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help in reducing pain and inflammation.
  • Padding and Cushioning: Using cushioned pads in the shoes, especially around the ball of the foot, can help relieve pressure on the sesamoid bones.
  • Orthotic Devices: Custom orthotics or insoles can be effective in redistributing pressure away from the sesamoid bones and correcting any biomechanical imbalances in the foot.
  • Footwear Changes: Wearing shoes with a low heel, soft soles, and a wide toe box can help reduce pressure on the sesamoids. Avoid high heels or tight shoes that can exacerbate the condition.
  • Physical Therapy: Exercises to strengthen the muscles around the foot and improve range of motion can be beneficial. A physical therapist can also provide guidance on proper foot mechanics.
  • Taping or Strapping: The toe may be taped or strapped to restrict movement and give the area a chance to heal.
  • Steroid Injections: In some cases, corticosteroid injections might be used to reduce severe inflammation. However, these are generally used cautiously due to potential risks.
  • Immobilization: In severe cases, the foot may need to be immobilized with a brace, cast, or walking boot to allow the inflamed area to heal.

As a last resort, surgery may be needed to remove the sesamoids.

What to Look for in Insoles for Sesamoiditis

When looking for insoles to relieve pain from sesamoiditis, we recommend looking for the following:

  • Cushioning and Shock Absorption: Look for insoles that offer good cushioning, especially around the ball of the foot, to reduce the impact on the sesamoid bones.
  • Metatarsal Pad: An insole with a built-in metatarsal pad can help redistribute pressure away from the sesamoids. This pad should be positioned just behind the ball of the foot to elevate and offload the sesamoid bones.
  • Arch Support: Proper arch support is important to maintain foot alignment and distribute weight evenly across the foot, reducing pressure on the forefoot.
  • Material Quality: The material should be durable and provide a balance between firm support and cushioning. Materials like gel or dense foam are commonly used.
  • Deep Heel Cup: A deep heel cup can stabilize the heel and improve overall foot alignment, indirectly reducing pressure on the front of the foot.
  • Custom Fit: While over-the-counter insoles might be effective, custom orthotics made to fit your specific foot shape and condition can offer more precise support and relief.
  • Flexibility: The insole should have some flexibility to allow natural foot movement, but it shouldn't be too flexible as it needs to reduce the bending force on the sesamoid bones.
  • Breathability: Materials that allow for air circulation can help keep the feet dry and comfortable, especially if you wear the insoles for long periods.
  • Compatibility with Shoes: Ensure that the insoles fit well within your shoes without making them too tight, as this could increase pressure on the affected area.

Remember, while insoles can provide significant relief, they should be part of a comprehensive treatment plan for sesamoiditis, which may include other therapies and modifications.