Pain Under the Big Toe Joint: Sesamoiditis

sesamoid pain

Pain under the big toe joint can be a significant nuisance, and can make walking, squatting, and jumping painful.  This pain is typically due to a common condition called sesamoiditis.  Sesamoiditis is inflammation of one of two small, egg-shaped bones found under the big toe joint., known as the sesamoid bones.  Every human has them, although some can have sesamoid bones that form in two or three separate pieces.  They provide an assisting role in bearing weight across the big toe joint and stabilizing certain tissue structures around the joint.

Injury to the sesamoids can immediately occur when falling onto the ball of the foot, directly kicking an object that forces the big toe upwards, or a direct crushing blow to the bottom of the foot.  The sesamoid bones can also become injured over a longer period of time when there is repetitive pressure on the ball of the foot from activities such as dancing, as well as during repetitive work-related activities, like pedal use in machinery or platform standing.

Symptoms of sesamoiditis can include a sharp pain or dull ache on the bottom of the big toe joint.  This pain becomes worsened when the toe is flexed in an upwards direction. Any activity that stresses this joint, including walking, running, and jumping, can cause pain.  This is especially true while one is barefoot. The use of supportive flat shoes tends to decrease the pain, while the use of high heeled shoes magnifies the pain. The tissue under the big toe joint may feel swollen or full, and may even be warm to the touch in less common cases.

Sesamoiditis is diagnosed by a simple foot exam, although x-rays and sometimes MRI is used to rule out a more significant injury like a fracture or stress fracture.

Sesamoiditis is treated with anti-inflammatory medicine, either taken orally or injected in the form of a steroid compound (provided no stress fracture is suspected). The big toe joint is supported with padding or specialized inserts to reduce pressure underneath, or by modifying the activity that caused sesamoiditis in the first place.  The use of stiffer-soled shoes is also helpful.  More serious cases may require immobilization in a walking boot or in a cast for up to several months.  Cases that simply won’t heal with any of these measures may require surgical intervention.  Surgical removal of one of the sesamoids is typically effective at eliminating the pain, and is sometimes also necessary when stress fractures or true fractures won’t heal.

While sesamoiditis only involves one small part of the foot, it nonetheless can be very painful and can limit both athletes and simply active people in a significant way.  Fortunately, it can be treated, but the road to recovery can be long if not treated early on and with all the necessary measures to address both the inflammation as well as the underlying cause of this condition.

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