Sesamoiditis of the Foot – Causes, Treatments, and Prevention

If you’ve got pain in the ball of the foot near your big toe, you could suffer from sesamoiditis of the foot. This can become debilitating, especially if you have to be on your feet during the day.

The good news is that there are steps you can take to treat sesamoiditis and prevent it from coming back. It may require some changes to your lifestyle, but avoiding aching forefoot pain that stops you from living your life to the fullest is worth it!

Here’s everything you need to know about this foot condition and how to deal with it if you have it.

What Is Sesamoiditis and What Causes It?

Sesamoiditis is a type of tendonitis that happens in the big toe. The tendons in the toe contain two small bones embedded with them—sesamoid bones. When the tendons become inflamed, these small bones also become inflamed and cause pain.

These tiny bones are only connected to the tendon, so every stress that affects the tendon affects these bones as well. The bone closer to the middle of the foot—the medial sesamoid—is often more affected than the one closer to the outside of the foot—the tibial sesamoid.

This tendon in the foot can become inflamed due to overuse, excessive pressure on the forefoot, or incorrect foot biomechanics. In some cases, those with gout can develop the condition as a side effect.

People who are more prone to developing sesamoiditis of the foot include runners, dancers, athletes who take part in high-impact activities, those with high arches or flat feet, those who wear high heels often, and people who have gout.

Symptoms of Sesamoiditis

Sesamoiditis of the foot develops gradually over time. You may first notice a dull ache underneath the big toe, but it’s usually light and easy to handle initially.

Over time, this pain can worsen, accompanied by swelling, redness, bruising, stiffness in the big toe, and difficulty bearing weight on the affected foot.

The location of the pain may also cause you to alter your gait, which can, in turn, lead to other foot problems.

The Difference Between Sesamoiditis and Gout

Sesamoiditis may occur as a result of gout, but not always. However, it can be difficult to tell if your big toe pain is sesamoiditis or gout. Sesamoiditis of the foot is caused by overuse of the tendon in the foot, while gout is caused by a build-up of uric acid in the joint.

Both conditions cause pain, redness, swelling, and stiffness in the big toe joints. However, in most cases, gout flares up suddenly and tends to ease up and flare up randomly. Sesamoiditis builds up gradually, and the pain gets worse over time.

Gout also often causes excruciating pain in the big toe at night, and you may be unable to even have the blanket touching your toe. The pain of sesamoiditis can occur at any time but is often at its worst after activity that places pressure on the ball of the foot.

To be able to treat your foot properly, it’s important that you get a proper diagnosis. Treating one when you actually have the other will result in ineffective treatment, and your pain will remain.

Treatment of Sesamoiditis

In most cases, some simple lifestyle changes will be enough to treat your sesamoiditis and prevent it from coming back. If you’re struggling with sesamoiditis of the foot, try some of these tips to ease the pain.


The first thing you need to do is to rest the affected foot. As sesamoiditis occurs from overuse, resting the foot will give the bones and tendon time to heal.

As well as taking a break from any activity that may aggravate the big toe, you can ice the area to reduce swelling and ease the pain. Wrap an ice pack in a thin cloth, t-shirt, or towel and place it on the foot a few times a day for 15 to 20 minutes at a time.

Elevating the foot can also help to reduce swelling and allow built-up fluids to drain away from the area.


Movement of the toe can cause the pain to worsen. Taping the toe can help to restrict movement, alleviating the pain. However, it won’t allow you to continue with the activity, as it will prevent your full range of motion.

Physical Therapy

If your range of motion is badly affected, your doctor may recommend physical therapy. A physical therapist can gently move the affected toe to restore your range of motion and may also use modalities like ultrasound or heat therapy to get your toe moving comfortably again.

Steroid Medication

In some cases, your doctor may choose to treat your sesamoiditis with steroid injections. This is usually only in severe cases when the pain and inflammation is excessive and affects your everyday life.

You may also treat your own pain and inflammation with NSAIDs, like ibuprofen. These are usually available over the counter and can help to reduce inflammation and ease pain when used as a management measure.


Surgery is a last resort and is usually only considered when other treatment methods have failed, and the pain is becoming debilitating.

Usually, one of the sesamoid bones is removed, taking the pressure off the area and significantly reducing pain and inflammation.

Tips to Prevent Sesamoiditis of the Foot

Prevention is better than cure, as they say! Follow these tips to prevent sesamoiditis of the foot from occurring. In most cases, these conservative management tips will be enough to reduce your pain.

Change/Replace Your Shoes

In many cases, the shoes you’re wearing can contribute to sesamoiditis of the foot. You may need to change your shoes if they don’t have enough cushion under the ball of the foot or if they have a cramped toe box.

Your shoes should allow enough space in the forefoot so that your toes can wiggle and your foot isn’t cramped or squashed.

There should also be sufficient padding under the forefoot, which is less common in shoes but will help to absorb shock and protect the sensitive area.

You should replace your shoes every six months so that you aren’t walking on worn-out cushioning. Ladies should also avoid wearing high heels as much as possible, as they place excessive strain on the ball of the foot.

You may want to try a shoe with a lower heel-to-toe drop. This can relieve pressure on the forefoot and distribute your body weight evenly across the foot.

It’s also important to choose the right shoes to support your foot. If you have high arches or flat feet—both of which can contribute to developing sesamoiditis of the foot—you may need a shoe with strong arch support or a stability shoe with extra support features.

Try Orthotics

Custom-made orthotics can add cushioning to the ball of the foot and help to spread your body weight evenly across the foot, alleviating pain and pressure. You can also find insoles for sesamoiditis over the counter.

In some cases, rather than full orthotics, metatarsal pads—or sesamoiditis pads—can be sufficient to ease pain in the ball of the foot. However, those with high arches or flat feet may need extra support from an orthotic.

Change Your Exercise

High-impact exercise can place a large amount of pressure on the forefoot. If you take part in sports like running, basketball, or other activities that require jumping or hard landing, you may have to change your chosen exercise to alleviate your foot pain.

Choosing low-impact exercises instead can significantly ease the pain and inflammation in the ball of the foot. These include sports like cycling, swimming, rowing, elliptical, or even just walking, which can help reduce foot pain.

CDC. (2019). Gout. CDC. 

Sesamoid Bone – an overview | ScienceDirect Topics. (2019). 

Sims, A. L., & Kurup, H. V. (2014). Painful sesamoid of the great toe. World Journal of Orthopedics, 5(2), 146–150. 

Sesamoiditis. (n.d.). Physiopedia. Retrieved October 3, 2022, from