Sesamoiditis is an inflammation of the sesamoid bones in the ball of the foot and the tendons they are embedded in. It’s usually caused by overuse, especially by dancers, runners and athletes who frequently bear weight on the balls of their feet. It's treated with rest and anti-inflammatory medication.
Sesamoiditis is a specific kind of tendonitis — inflammation of the tendons — that occurs in the ball of the foot. Because the tendons in the ball of the foot have small sesamoid bones embedded in them, these bones can become inflamed along with the tendons. The two pea-sized sesamoid bones sit under the big toe joint, where they provide leverage when the tendons load weight onto the ball of the foot. Activities that frequently transfer weight to the ball of the foot — including running, dancing and walking in high heels — can overstress these tendons and bones, causing inflammation and pain.
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While most bones in the body are connected to other bones, sesamoid bones are unique in that they are only connected to tendons. They interact with the tendons as they move and are subject to the same stress from the same movements. Sesamoid bones exist in the feet, hands and knees, but sesamoiditis always refers to the foot bones. These bones bear the additional stress of shock absorption from walking. The sesamoid closer to the middle of the foot, the medial sesamoid, bears more of this stress and is more often affected, but the tibial sesamoid can be affected too.
Sesamoiditis is usually caused by overuse of the tendons that interact with the sesamoid bones in the foot. Runners, dancers and athletes get it from over-practicing movements that transfer weight to the ball of the foot. People who wear high heels, who have very high arches or very flat feet or who walk with an inward roll can get it just from walking. Rarely, it can also be a side effect of gout.
Sesamoiditis from overuse develops gradually. You may notice a dull ache under the big toe that builds until it becomes difficult to walk. Symptoms can include:
Anyone can get it, but people whose regular activities cause more repetitive stress to the tendons and sesamoid bones in the feet are more prone to get it. This includes:
Your healthcare provider will ask you about how the pain started and then begin by physically examining the foot. They will gently check for tenderness in the ball of the foot and move your big toe in different directions to test your mobility. They might use a technique called the Passive Axial Compression test that manipulates the joint in a similar way to walking in order to reproduce the symptoms of sesamoiditis. They might also use imaging tests to confirm or rule out certain related conditions.
Your sesamoiditis could be accompanied by a stress fracture, a small crack in the bone caused by repetitive stress. If your healthcare provider suspects an acute injury, they might want to screen you for an acute bone fracture or turf toe, an injury of the soft tissue around the sesamoid bones. If you’ve previously injured your big toe joint, they might want to rule out hallux rigidus, a kind of degenerative arthritis that affects that joint. Imaging tests might include X-ray, bone scan, CT scan, ultrasound or MRI.
Sesamoiditis can be mild or severe, and recovery time depends on the severity. Mild cases may resolve within days, while more severe cases can take months. Surgery will prolong recovery time.
Most cases of sesamoiditis will begin to improve immediately when you stop the activities that were causing repetitive stress to the joint. The tricky part will be safely resuming those activities. Follow your healthcare provider’s guidance on this, as well as your own body signals.
Sesamoiditis can always occur again. It can also do permanent damage if it’s not allowed to fully heal, or if you wait too long to seek treatment. To avoid chronic sesamoiditis and permanent damage, stay aware, take your pain seriously and practice preventative care.
While sesamoiditis is caused by overuse, gout occurs due to a buildup of uric acid. Gout can affect any joint, but it commonly occurs in the big toe. In most cases, gout flare-ups begin suddenly while sesamoiditis pain is gradual. Keep in mind, however, that a proper diagnosis is necessary to determine which condition is affecting your toe.
No. Though both conditions affect the big toe, they are different in nature. Turf toe — medically known as a metatarsophalangeal joint sprain — is an injury that occurs when the big toe joint extends beyond its normal range. The pain develops suddenly and is usually accompanied by immediate pain and swelling. Conversely, sesamoiditis is a condition that results from overuse. Sesamoid pain usually develops gradually over time.
Yes. It’s possible to fracture a sesamoid bone. This is usually caused by a direct blow to the foot, though it can also be due to repetitive stress. Treatments for a broken sesamoid bone may include:
A note from Cleveland Clinic
Sesamoiditis can sneak up on you. It might start as a vague ache and then one day erupt into intense throbbing pain. Repetitive stress injuries like sesamoiditis occur when we ignore our body’s smaller stress signals until it decides to crank up the volume. When it gets to that point, we’ll regret it — especially if it means a long recovery period avoiding our usual activities. Take the health of your feet into your own hands by practicing preventative care. Pay attention to pain signals, and give your feet a rest after working them hard. When pain persists, seek treatment right away. Getting off your feet sooner will help you get back on your feet sooner.
Last reviewed by a Cleveland Clinic medical professional on 08/06/2021.
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