Sesamoiditis

Sesamoiditis is inflammation and irritation of the two small bones (the sesamoids) located beneath the big toe joint, along with the surrounding tendons. It typically causes pain in the ball of the foot, just under the big toe, and is common in runners, dancers and people who spend long periods on the balls of their feet.

What is sesamoiditis?

Your sesamoids are two pea-sized bones embedded in the tendons under the head of the first metatarsal — the joint at the base of your big toe. They act like tiny pulleys, helping the big toe move and absorbing pressure when you push off the ground. When these bones and their tendons become overloaded, irritated or inflamed, the result is sesamoiditis.

What causes sesamoiditis, and what are the symptoms?

Sesamoiditis usually develops from repetitive stress or sudden increases in activity. Common contributing factors include:

• Running, jumping, dancing or other high-impact activity
• A sudden spike in training load or footwear changes
• High-arched feet or a tendency to bear weight on the ball of the foot
• Tight calves or limited big-toe movement
• Footwear that offers little cushioning, or high heels

Typical symptoms include:

• Pain and tenderness directly beneath the big toe, especially when walking or weight-bearing
• A dull ache or throbbing in the ball of the foot
• Swelling or, occasionally, redness
• Difficulty bending or straightening the big toe
• Pain that eases with rest and returns with activity

How is sesamoiditis diagnosed at Blueprint Podiatry?

Assessment begins with a detailed discussion of your symptoms, activity levels and footwear, followed by a hands-on examination of the foot and big toe joint. Because the sesamoids play a key role in how you load and push off, our podiatrists may complete a gait and running assessment — every podiatrist at Blueprint Podiatry is a certified running coach, so we look closely at how you move, not just where it hurts.

Where appropriate, we may refer for imaging such as X-ray or MRI to confirm the diagnosis and rule out other causes of forefoot pain, including a sesamoid fracture or stress reaction.

How is sesamoiditis treated?

Treatment is usually conservative and focused on offloading the area while it settles. A systematic review of conservative care for sesamoiditis supports approaches such as activity modification, footwear changes and orthotic management [1]. Your plan may include:

• Rest and activity modification to reduce repetitive load
• Supportive, cushioned footwear with a stiffer sole to limit big-toe bend
• Custom orthotics to offload pressure from the sesamoids — at Blueprint Podiatry these are 3D scanned while weightbearing and 3D printed in-house, with patient-matched left/right devices
• Padding and strapping to redistribute pressure
• Foot mobilisation therapy and targeted strengthening to restore movement and function
• Additional clinic modalities such as shockwave therapy or dry needling where clinically indicated

We tailor each plan to your foot, your goals and your activity — whether that's returning to running or simply walking comfortably again.

When should I see a podiatrist?

If forefoot pain persists beyond a few days, worsens, or stops you walking or training normally, it's worth having it assessed. Early management may help prevent the condition becoming chronic.

Related services

• Customised Orthotics
• Running Biomechanical Assessment