Sesamoiditis (Big Toe Joint Pain)

What is Sesamoiditis?

Sesamoiditis is an inflammation of the sesamoid bones, which are two small bones located beneath the big toe joint (1st metatarsophalangeal joint).

These bones act like pulleys to help the big toe move efficiently during walking and running.

Aetiology (Causes)

Sesamoiditis is usually caused by repetitive overload and pressure under the big toe, including:

• Forefoot overloading

• High-impact activities (running, jumping)

• Tight Achilles tendon and plantar fascia

• Limited ankle mobility

• Muscle imbalance

• Foot structure (e.g., high arch or prominent sesamoids)

• Inappropriate footwear (thin or unsupportive soles)

From a biomechanical perspective, excessive pressure under the first metatarsal head leads to irritation of the sesamoid bones.

Symptoms

Patients commonly report:

• Pain under the big toe joint (ball of foot)

• Pain during push-off phase of walking

• Tenderness when pressing under the big toe

• Swelling or inflammation

• Difficulty walking barefoot

Progressive Signs

• Increased pain with activity

• Reduced ability to push off

• Altered gait (compensation to lateral foot)

Why symptoms occur

• Repetitive stress on sesamoid bones

• Increased pressure under the 1st metatarsal

• Compensation due to tight calf and plantar fascia

This leads to:
➡️ overload → inflammation → pain → altered gait

Management Approach (Podiatry Perspective)

Non-Surgical Management (First-Line)

• Offloading pressure

  • Padding (e.g., dancer’s pad)

  • Footwear modification

• Orthotic therapy

  • Redistributes pressure away from sesamoids

• Footwear advice

  • Cushioned shoes with good forefoot support

  • Avoid thin soles and high heels

• Activity modification

  • Reduce high-impact loading

• Stretching

  • Achilles tendon

  • Plantar fascia

✔️ Aims to reduce load and allow tissue recovery

When is Surgery Needed?

Surgery is rare and only considered when:

• Pain is persistent and severe

• Conservative treatment fails

Personalised Care at Pod11

At Pod11, we provide a one-to-one personalised program focusing on:

• Offloading the sesamoid region

• Improving foot mechanics

• Reducing soft tissue tension

• Preventing recurrence

Key Takeaway

• Sesamoiditis is a pressure-related condition under the big toe

• Most cases improve with non-surgical care

• Early offloading and proper footwear are essential