Sesamoiditis

Soft Tissue Conditions· Also known as: sesamoid inflammationUpdated Oct 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

Sesamoiditis is a painful overuse problem of the two small, pea-shaped bones under your big toe joint, and of the soft tissue around them. In athletes it is seen often: one review puts it at 4.2 per cent. It isn't clear how common it is in the general public. The main symptom is pain under the big toe joint that is worse when you walk, push off or go up on your toes. Most people improve with changes to footwear, insoles and activity, but it can come back.

What is it?

Under the joint at the base of your big toe sit two small, pea-shaped bones called sesamoids. They are set into a tendon (a cord that links muscle to bone). They protect the joint and help pull your big toe downwards.

Sesamoiditis means these bones, or the soft tissue around them, have become irritated and painful. It is usually an overuse problem. The word is a broad one and is often used once other causes of sesamoid pain, such as a broken bone, have been ruled out. Because of that, it is not a good idea to decide for yourself that this is what you have.

Who does it affect?

Sesamoiditis is seen in young, active people. It is more often seen in younger women. In athletes, one review found that it made up 2.2 per cent of all lower leg and foot injuries, and 18.3 per cent of injuries to the big toe joint.

People who dance, run, jump or play ball sports are most at risk. Dancing, running and football together account for 60 per cent of sesamoid injuries in the big toe.

Signs and symptoms

The main symptom is pain under the big toe joint, in the ball of your foot. Some people feel a more spread-out ache across the underside of the big toe. The pain can start suddenly or build up slowly.

It is usually worse when you walk, put weight on the foot, push off or go up on your toes. It often eases when you take the weight off. After a knock or injury, there may also be swelling and bruising. Your big toe joint may feel stiff or sore when it is bent upwards.

What causes it?

Your sesamoids take a lot of load. The bones under your big toe joint normally carry up to half your body weight, and more than 300 per cent of it when you push off. That makes them easy to overload.

Common triggers include:

a sudden increase in activity or training
running, jumping, dance, tennis, basketball and soccer
regular high heels or unsupportive shoes
a high-arched foot, or a foot that rolls in too much (excessive pronation)
earlier big toe problems, such as turf toe (an injury from the big toe bending too far upwards) or a stiff big toe joint
direct knocks to the big toe, or the big toe being forced upwards

These are things that tend to go along with sesamoiditis. They don't mean you will definitely get it.

How is it diagnosed?

Your podiatrist will ask about your pain, your activity, your shoes and any recent changes. They will press on the area, move your big toe joint and watch you walk. They may compare the sesamoids on both feet. It helps to note when the pain happens and what eases it.

Many people don't need scans. X-rays are often normal in sesamoiditis. If the cause is unclear or the pain isn't settling, your clinician may arrange an X-ray, MRI or bone scan to check for other problems.

Other things can cause pain in the same spot, and your clinician will think about them:

a broken sesamoid, including a stress fracture (a small crack from repeated load)
a sesamoid that is naturally in two parts, which can look like a fracture on an X-ray
loss of blood supply to the bone
infection
wear-and-tear arthritis
bunions, a stiff big toe joint, turf toe or gout

Gout usually brings sudden pain, swelling and redness around the joint.

Treatment

Treatment usually starts with taking load off the sesamoids. The options that have been looked at most give short-term relief, and pain can return. It isn't yet known which approach works best.

Looking after it at home

Cut back on what loads the ball of your big toe, such as running, jumping and time up on your toes. At first, some people need a short period of reduced weight on the foot, or a boot or shoe that keeps weight on the heel. Choose wide shoes with a low heel, as low heels take pressure off the sesamoids. Rest and gentle stretching, including of your calf, are part of the plan.

Treatment from your podiatrist

Your podiatrist can check your footwear and activity, and may suggest offloading insoles (also called orthoses) or padding. These take pressure off the sesamoids and are among the most helpful options. After the first painful phase, a type of insole called a Morton extension, or a small pad, may help.

Pain relief such as anti-inflammatory medicines may be used for a short time. Ask your GP or pharmacist whether they are safe for you.

Other options

If pain continues after sensible home care and offloading, a corticosteroid (cortisone) injection guided by ultrasound or X-ray may be considered. It can give short-term relief, but pain can return. It should not be used if a broken sesamoid or loss of blood supply to the bone is present or hasn't been ruled out.

Your clinician may refer you on if you haven't improved in a reasonable time, if another health problem may be behind the pain, or if you need care beyond what your podiatrist offers. You might see an orthopaedic surgeon, sports medicine doctor or foot and ankle specialist.

Surgery

Surgery is a later option, kept for carefully chosen people after a team assessment and thorough non-surgical care. It can have downsides, including the big toe drifting sideways (a bunion), weaker push-off and a change in the way you walk. For a stress fracture in an athlete, 2 to 6 months of non-surgical care is often tried first. Surgery is considered if symptoms continue.

Recovery

Most symptoms settle with changes to footwear, insoles and activity, including rest and stretching. How long that takes isn't clear, and it varies from person to person. If nothing has changed after six to twelve weeks, or if pain increases a lot after exercise, get it reviewed.

Some people find that younger age, a higher body weight (BMI) or a naturally two-part sesamoid make it harder to settle with non-surgical care. Pain can come back, and some people don't fully regain their function. A stress fracture of these bones can take longer to heal.

Preventing it

It isn't yet clear whether any particular shoe, insole or training plan stops sesamoiditis coming back. Still, it makes sense to avoid the things linked with it.

Build up running, jumping, dance and standing time gradually, and avoid sudden jumps in activity. Keep to low-heeled, supportive shoes while you recover, and avoid regular high heels. If pain keeps returning, ask your podiatrist about offloading insoles. If you play sport or dance, return in steps rather than straight to full load.

When to see a podiatrist

Book an appointment if

Your ball-of-foot pain hasn't improved after 2 weeks of home care, it is stopping your normal activities, or it comes with tingling or loss of feeling in your toe: see your GP. Book an appointment with your podiatrist or see your GP soon if there is no change after six to twelve weeks, or if the pain increases a lot after exercise. If you have diabetes and foot pain, see your GP soon.

Seek prompt assessment if

You suddenly can't put weight on your foot. Your foot is red, hot or swollen, which is urgent if you have diabetes. You heard a snap, grinding or pop when you hurt it, or you feel faint, dizzy or sick from the pain. You have severe pain that never eases, or you have a fever and feel unwell. In each case, see your GP or another doctor today. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. If you think your foot might be broken, don't try to treat it yourself. Also see your GP soon if pain at night stops you sleeping, or if you are losing weight without trying.

Frequently asked questions

How can I tell if it's sesamoiditis or a broken sesamoid?

You can't reliably tell by yourself. The two can feel alike, and some people are born with a sesamoid in two parts (7 to 30 per cent), which can look like a break on an X-ray. Your clinician will use your history, an examination and sometimes imaging to sort this out.

Can I keep exercising?

Cut back on activities that load the ball of your big toe, such as running, jumping and repeated tip-toe work, while it settles. Stop any exercise if the pain increases or you feel unwell. Return gradually rather than at full load, and ask your podiatrist what suits you.

Is it safe to take anti-inflammatory painkillers?

They are sometimes used for a short time to ease pain. Whether they suit you depends on your health and other medicines, so check with your GP or pharmacist first.

Who might I see about it?

Your podiatrist is a good first stop. Depending on how things go, you may also see a GP, sports medicine doctor, foot and ankle specialist or orthopaedic surgeon.