S is for Sesamoiditis

November 4, 2012

The sesamoid bone are those small bones under the big toe joint that function like mini-knee caps. Sesamoiditis is an inflammation of the structures around these bones.

Sesamoiditis is a condition characterized by inflammation and pain in the sesamoid bones, which are two small, pea-shaped bones located beneath the base of the big toe in the foot. The sesamoid bones act as pulleys, providing leverage to the tendons that help move the big toe. Sesamoiditis typically develops gradually and is often caused by repetitive stress or overuse of the foot.


  1. Overuse and repetitive stress: Activities that involve repeated pressure or impact on the forefoot, such as running, dancing, or jumping, can contribute to the development of sesamoiditis.
  2. High-impact sports: Sports that involve quick and forceful movements, such as basketball or tennis, can increase the risk of sesamoiditis.
  3. Foot structure and biomechanics: Factors like having a high arch, a prominent or enlarged sesamoid bone, or excessive inward rolling of the foot (pronation) can put additional stress on the sesamoid bones.
  4. Footwear: Wearing shoes that lack adequate cushioning, support, or have a tight toe box can contribute to sesamoiditis by increasing pressure on the forefoot.


  1. Pain: The primary symptom of sesamoiditis is localized pain beneath the base of the big toe. The pain may be dull, aching, or throbbing and typically worsens with activity.
  2. Swelling and inflammation: The affected area may appear swollen, red, or warm to the touch.
  3. Difficulty bearing weight: Walking or bearing weight on the ball of the foot can be painful and challenging.


  1. Rest and activity modification: Reducing or avoiding activities that exacerbate the pain is important to allow the sesamoid bones to heal. Switching to low-impact exercises and incorporating cross-training activities can help maintain fitness without placing excessive stress on the foot.
  2. Ice therapy: Applying ice packs to the affected area for 15-20 minutes several times a day can help reduce pain and inflammation.
  3. Pain management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and reduce inflammation.
  4. Footwear modifications: Wearing shoes with cushioning and support, particularly in the forefoot area, can help alleviate pressure on the sesamoid bones. Inserts or orthotics may be recommended to provide additional cushioning and correct biomechanical issues.
  5. Padding and offloading: Placing pads or cushions beneath the affected area can help relieve pressure and reduce pain. Offloading devices, such as a walking boot or crutches, may be necessary in severe cases to allow for complete rest.
  6. Physical therapy: A physical therapist can provide exercises to improve foot strength, flexibility, and balance. They may also suggest techniques to modify gait and reduce stress on the sesamoid bones.
  7. Injections: In some cases, corticosteroid injections may be used to reduce inflammation and pain.
  8. Surgical intervention: Surgery is rarely required for sesamoiditis. However, if conservative treatments do not provide relief, and there is persistent pain or significant damage to the sesamoid bones, surgical removal of the affected sesamoid bone(s) may be considered as a last resort.


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