Sesamoid Injuries

Pain in the Ball of the Foot Beneath the Big Toe Joint

What could be my problem?

A sesamoid injury occurs when a bone becomes embedded in a tendon in the bottom of the foot. In a normal foot, the sesamoids are two pea-shaped bones located in the ball of the foot beneath the big toe joint.

Acting as a pulley for tendons, the sesamoids help the big toe move normally and provide leverage when the big toe pushes off during walking and running.  The sesamoids also serve as a weight-bearing surface for the first metatarsal bone (the long bone connected to the big toe); absorbing the weight placed on the ball of the foot when walking, running and jumping.

Sesamoid injuries can involve the bones, tendons and/or surrounding tissue in the joint.

Types of Sesamoid Injuries:

  • Turf Toe:  injury of the soft tissue surrounding the big toe joint when it is extended beyond its normal range. Turf Toe causes immediate, sharp pain and swelling, and may result in injury to soft tissue attached to the sesamoid or a fracture of the sesamoid.
  • Fracture: can be either acute or chronic
    • Acute Fracture: is caused by trauma – a direct blow on impact to the bone.  Acute Fractures produce immediate pain and swelling to the sesamoid site but does not affect the entire big toe joint.
    • Chronic Fracture:  is a stress fracture (a hairline break usually caused by repetitive stress or overuse).
  • Sesamoiditis:  is an overuse injury involving chronic inflammation of the sesamoid bones and tendons involved with those bones. Sesamoiditis is associated with a dull, longstanding pain beneath the big toe joint.  Foot pain comes and goes, usually occurring with certain shoes or certain activities.

What causes Sesamoid injuries?

  • Activities requiring increased pressure on the ball of the foot; such as running, basketball, football, golf, tennis and ballet
  • High arches Frequent wearing of high heeled shoes

When to see a foot pain doctor about sesamoid injuries:

  • If your pain is focused under the big toe on the ball of the foot. With sesamoiditis, foot pain may develop gradually, whereas with a fracture, the pain will be immediate.
  • If you have difficulty and foot pain when bending and straightening the big toe

Note: Swelling and bruising may or may not be present

If I have a Sesamoid injury, what are my foot pain treatment options?

Treatment options for a sesamoid injury will vary based on the type of Sesamoid injury that a podiatrist diagnoses on an individual basis.

Non-Surgical Treatment Options:

  • Sesamoiditis:
    • Rest
    • Ice
    • Soft-soled, low-heeled shoes,
    • Foot cushioning pad
    • Taping or bracing the foot
    • Steroid injection therapy
  • Sesamoid Fractures: 
    • Stiff soled shoesShort leg fracture brace 
    • Taping
    • J-shaped sesamoid pad (also known as dancer’s pads)
    • Custom orthotic devices

Surgical Treatment Options:

With a diagnosis of sesamoiditis, treatment is usually non-operative.  However, if conservative measures fail surgery may be recommended to remove the sesamoid bone in the foot.  Occasionally, surgical fixation of a fractured sesamoid is needed.