Sesamoiditis Causes, Symptoms & Treatment Options

Overview

The sesamoid complex sits within the soft tissue beneath the big toe and includes two small bones:

• Tibial sesamoid – the larger of the two, located on the inner side of the foot.
• Fibular sesamoid – the smaller bone, located on the outer side of the foot.

Unlike other bones in the body, sesamoid bones do not connect to other bones through joints. Instead, they are embedded in tendons, helping with weight absorption, pressure distribution, and smooth movement of the big toe. These bones play a key role in walking, sprinting, dancing, and any motion requiring a strong push-off.

What causes Sesamoiditis?

Sesamoiditis usually develops from repetitive stress, particularly during running, dancing, jumping, or other high-impact activities. Movements that forcefully bend the big toe upward or place continuous pressure on the ball of the foot can irritate the sesamoid bones. Direct trauma, such as stumbling or landing awkwardly, may also trigger inflammation or even a sesamoid fracture.

Other contributing factors include:

• Poor foot alignment or improper training technique
• Wearing unsupportive shoes or high heels
• Increased pressure on the forefoot during long workouts
• Tight calf muscles or weak foot muscles

Any of these factors can overload the sesamoid bones and result in persistent pain in the ball of the foot.

Other contributing factors include:

• Poor foot alignment or improper training technique
• Wearing unsupportive shoes or high heels
• Increased pressure on the forefoot during long workouts
• Tight calf muscles or weak foot muscles

Any of these can overload the sesamoid bones and lead to persistent ball of foot pain.

How the Injury Occurs: Sesamoiditis develops when repeated pressure or force is placed on the big toe joint. Over time, the tissues surrounding the sesamoid bones become irritated and inflamed, causing pain with movement and weight-bearing. In athletes, the injury often results from constant pushing off, sprinting, or rapid changes in direction that overload the front of the foot.

Common Everyday Causes: You don’t need to be an athlete to develop sesamoiditis. Everyday activities such as walking long distances in hard-soled shoes, wearing high heels, or standing for long hours can strain the sesamoid bones. People with naturally high arches or those who frequently kneel or squat may also place extra pressure on the forefoot, increasing their risk.

Sports Where Sesamoiditis Is Common

Sesamoiditis frequently affects athletes in high-impact or high-pressure sports, including:

• Aerobics – continuous jumping increases pressure on the big toe.
• Dance – especially ballet, which requires pointe positions.
• Football & Soccer – repeated sprints and direction changes stress the forefoot.
• Gymnastics – hard landings can irritate the sesamoid bones.
• Baseball & Softball – quick bursts of movement strain the big toe joint.
  
• Track and field – long-distance running often overloads the sesamoids.

Any sport involving running, jumping, or pushing off can contribute to sesamoiditis.

Symptoms

Sesamoiditis often develops gradually, beginning with soreness in the ball of the foot that worsens with activity. Over time, the pain may become sharp or persistent, making walking and other movements difficult. 

Common symptoms include: 

• Nonspecific pain in the foot or big toe area that increases with movement
• Pain when pushing off during walking or running
• Tenderness when touching the sesamoid bones
• Swelling or redness beneath the big toe
• Stiffness in the big toe joint

If a sesamoid fracture is present, the pain may be more intense and occur suddenly after a traumatic event.

Non-operative treatment

Most cases of sesamoiditis improve with non-surgical care, especially when treated early. Your doctor may recommend:

• Rest – reducing or stopping the activities that worsen the pain
• Ice therapy – to decrease inflammation
• NSAIDs – like ibuprofen or aspirin for pain relief
• Toe taping – to support the big toe and limit movement
• Soft tissue therapy – such as massage or stretching
• Orthotics – custom inserts or pads to relieve pressure on the sesamoid bones
• Sesamoiditis exercises – strengthening and stretching routines that support healing

These treatments help reduce stress on the affected bone and allow the area to calm down.

Below is a PDF of the Exercise Program: 

Sesamoiditis

Surgical Treatment

Surgery is considered only when sesamoiditis treatment fails after several months or when a sesamoid fracture does not heal properly. Surgical options may include:

• Partial or complete removal of the sesamoid bone
• Shaving down a prominent tibial sesamoid to reduce pressure
• Rare complete excision of both sesamoids (only for severe, complicated cases)

Surgery is typically a last resort because removing sesamoid bones can affect toe alignment and long-term foot mechanics.