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Sesamoiditis is a common disorder that affects the forefoot. It is more prevalent in young people, who are very active in physical activities like sports and dancing. This condition is mainly characterized by inflammation of the sesamoid bones as well as the tissues surround them. The sesamoid bones under the toes are the most affected.

Some foot specialists consider it a form of tendinitis. Athletes and dancers are more likely to suffer from this condition, since they tend to exert more weight on the forefoot as they engage in their various activities. Similar to other inflammatory conditions, sesamoiditis causes severe pain. In most situations, the pain is felt right under the first metatarsal at the toe joint. As time progresses, the condition becomes worse, thus increasing pain in the process.

What Causes Sesamoiditis?

This disorder can develop in numerous ways. When inflammation occurs in the tissues surround the sesamoid bones, the condition becomes sesamoiditis. This foot condition is often caused by undertaking various types of toe movements repeatedly. As previously highlighted, such movements are very common in dancing and athletics. Fractures can also lead to sesamoiditis. When you fall and land with a great impact on the ball of your foot, you will be placing too much impact in that region. As a result, the stress incurred leads to fractures of the sesamoid bones, leaving you with great pain and distress. Stress fractures can also lead to pain in the sesamoid bones.

Stress fractures usually occur when you overwork the soft tissues surrounding the sesamoid bones. Due to the repeated and heavy demands of training sessions, athletes suffer stress fractures on the sesamoids frequently. Their trainings place too much stress and impact on the soft tissues surrounding the big toe and the foot. Another main cause of sesamoiditis is arthritis of the foot. When arthritis occurs at the location where the sesamoid bones slide beneath the bone of the big toe, sesamoiditis is most likely to occur. There is a joint where the sesamoid bones glide under the bone of the large toe. Similar to other joints in the body, arthritis can also develop here. People who have high arches are more prone to this form of arthritis.

When people with high arches fail to wear the right type of footwear, the main joint in the big toe becomes rigid. Due to this rigidity, there is pressure and strain in the sesamoids. In other instances, there is decreased blood supply to the sesamoid bone, a condition known as osteochondritis. Osteochondritis is a disorder where a piece of the sesamoid bone dies. As the body attempts to heal, there is build up of extra calcium around the area, which leads to pain and discomfort during walking. Sesamoiditis can also be caused by extra tissue beneath the big toe, a condition called intractable plantar keratosis.

What are The Symptoms of Sesamoiditis?

Sesamoiditis is usually characterized by pain when walking. However, any load bearing activity or exercise can lead to pain. It occurs in two main stages, which are the acute stage and the chronic stage. During the acute stage, the sesamoids are sensitive and sore whenever you place direct pressure on them, feeling of slight pain when walking bare foot or when wearing shoes with thin soles, pain reducing with rest, slight swelling at the back of the sesamoids, which reduces upon rest. If sesamoiditis has extended to the acute shortage, you will be experiencing continuous pain beneath the sesamoids, increased swelling that does not reduce even after rest, stiffness of the big toe because of swollen metatarsals.

Sesamoiditis Treatment Options

If you are dealing with intense and chronic pain in the ball of your foot, then you might be suffering from sesamoiditis. Treatment for this condition is straightforward. Rest is always the best way of easing the pain. Orthotic insoles and metatarsal bars can be highly useful in treating sesamoiditis. Sesamoiditis occurs due to various reasons, which were highlighted above. Some can be prevented while others cannot. Those that are not preventable are usually attributed to defects in the bones as well as people with enlarged sesamoid bones.

If you have bony feet, then you are at a higher risk of developing sesamoiditis since you have minimal foot padding for shock absorption. Additionally, since these bones bear a lot of weight, any condition that weakens them like osteoporosis can leave you exposed to this foot condition. Sesamoiditis can be caused by increase in the rate of exercise being carried out. This is more common during high impact activities like jumping, running and other highly exertive activities. The problem does not specifically develop from a single trauma. It results from gradual weakening and damage to the bones.

Therefore, if you exercise once per week, chances are minimal. However, if you engage in highly strenuous activities each day and your feet are not properly cushioned, you might start experiencing the pain after several weeks. Footwear that places greater stress and pressure on the ball of the foot is a major contributor to the development of sesamoiditis. Additionally, high-heeled shoes as well as shoes with a very short toe box and a narrow toe box can also increase the stress on these small bones.

There are various treatment options available for this condition. In fact, most can be applied at home. Moreover, pain can be treated using low cost corrective devices. Although home diagnosis is possible, it is advisable to consult a podiatrist or a physician, in order to get an accurate diagnosis. A podiatrist can advise you to insert a pad or an insole into your shoes, and the pain will be gone.

Rest and Take Pain Medication

If the pain to these pea-sized bones is due to increased exercises, it is advisable to take an extended rest. These bones together with the surrounding tissues get inflamed fast. Therefore, the addition of extra exercise will only worsen the condition. It is therefore important to rest for a few days, and stay away from any form of activity that places pressure on your feet. This will allow the inflammation to subside. You can also take pain medication such as Advil and Ibuprofen to reduce the pain and inflammation.

Ice Treatment

Application of ice treatment to inflamed areas, is one of the best means of alleviating such conditions. For purposes of your health, ensure that you stick to recommended drugs. Ice the affected area around four times per day. The icing should last a minimum of 15 minutes, to allow the procedure to penetrate to the inflamed tissues and bones. Apart from reducing the inflammation in the affected area, it will also offer the much-needed pain relief, while ensuring the swelling goes down.

Wear Flat Shoes

Many ladies cannot leave their homes when going for work or a date, without high-heeled shoes. As much as it is a fashion statement, you need to avoid them especially when suffering from this condition. If you are dealing with sesamoiditis, it is always advisable to wear flat shoes. Although this is a short-term measure, it will provide you with some relief, especially if your work involves leaving the house every day and walking for some distance. This helps to minimize the shock placed on the sesamoid bones. You can also insert a metatarsal pad on your flat shoes, to provide cushioning to the sesamoid bones when walking. This will ease the pain. Additionally, wearing good sport shoes as well as replacing them frequently when the cushioning degrades is also a recommended method of prevention.

Wearing Orthotic Insoles

As much as insoles are more of a prevention procedure, they can also be used during the treatment phase. They help to ensure that the condition does not worsen or develop. Orthotic insoles also help to prevent an existing condition from recurring. If you have been successfully treated from sesamoiditis, then you need the right type of footwear. Orthotic insoles come in handy during such a situation. Apart from orthotic insoles, you can also choose metatarsal bars or pads, to minimize the stress on the sesamoid bones. Ensure that the orthotics chosen are a full-length model, to ensure that all the bones are properly cushioned.

How can Sesamoiditis be prevented?

One of the best means of preventing various foot conditions, sesamoiditis being included, is wearing the right type of footwear. Various brands and models of footwear, like sports sneakers provide the feet with sufficient room for movement. They also allow correct bone positioning and alignment. Others come with large toe boxes, thus preventing cramping of the toes. Sneakers provide reliable underfoot cushioning. They feature EVA foam rubber midsoles, which helps in cushioning the bones of the feet. These foam midsoles also play a significant role in shock absorption in the feet.

As much as the uppers may look appealing and in excellent condition, underfoot cushioning tends to degrade at a faster rate. Once the cushioning degrades completely, the shoes will not be a in position to offer the right amount of shock absorption. If you jog or run daily, then you need to replace your sneakers after every 6 months. If you are more active than that, then you should consider replacing them after 4 months or so. Replacing your athletic sneakers regularly, you can always ensure that your shoes have the correct amount of cushioning and shock absorption, every time you wear them.

Orthotic Insoles

Similar to other conditions that affect the ball of the foot, sesamoiditis is usually caused by repeated stress and pressure on the ball of the foot. Jobs that need frequent crouching, carrying heavy loads as well as lifting up heavy loads, increases pressure on the sesamoids. Therefore, you need to make sure that the sesamoid bones have the correct amount of cushioning. This helps to prevent the problem. One of the best methods of providing extra cushioning is using orthotic insoles. Orthotic insoles are easy to insert in most types of shoes, thus helping to improve cushioning.

Orthotic insoles make sure that the foot is correctly aligned and positioned, thus preventing unnatural strain and stress on the ball of the foot. Although custom orthotics might prove to be very useful for people suffering from various gait irregularities, over the counter insoles will not be sufficient in most people. Instead, you should opt for high quality brands, which are very useful and effective in providing the right amount of cushioning. Such brands include Superfeet, Orthaheel, Spenco and Sorbothane, among others. They feature a robust construction, lasting up to 12 months, before they need a replacement.

Insoles with a metatarsal bar are the most preferred. They minimize the pressure and strain on the ball of the foot as well as the sesamoid bones. Orthotic insoles are also very essential for offering arch support, especially in people with high arches. People with high arches lack the right amount of shock absorption, when they are walking. This places increased force and pressure on the sesamoid bones. If you make sure that the arches have the right amount of support, there will be reduced pressure on the sesamoid bones, thus minimizing the pain. Insoles and arch support socks are also highly effective, when it comes to prevention of sesamoid injuries and fractures, for individuals with high arches.

Pronation Control

Overpronation is one of the chief causes of sesamoiditis, especially in joggers and runners. Pronation refers to the natural rolling of the feet, when running or walking, especially with the feet rolling slightly inwards. Overpronation refers to excessive rolling of the foot. When it happens, extra pressure is placed on the sesamoid bones. If you overpronate when jogging, walking, or running, then you should look for pronation control orthotic insoles and shoes. These will correct the problem and ensure that the feet assume a natural and healthier roll.

Manufacturers of high quality shoes like Brooks, Asics, Nike, and New Balance, produce shoes that can help in pronation control. Whether you are a moderate or a severe pronator, you can find the right type of footwear to improve your foot function while easing the pressure and stress on the sesamoid bones.

Bottom Line

Sesamoiditis can greatly reduce your level of activity and quality of life. Therefore, it is always advisable to seek treatment from qualified physicians, specifically podiatrists, when suffering from this foot condition. However, wearing the right type of shoes with the correct amount of cushioning and support, can prevent this condition.

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About the author


Hi, I’m Brian Bradshaw. I’m a super duper mega hiking enthusiast, with a love for everything that has to do with outdoors, hiking, gear, footwear and more.

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4 thoughts on “Sesamoiditis”

  1. Please recommend a fashionable, black, zippered, knee height, RIGID sole ladies boots with a low heel, that is not a work boot, for sesamoiditis. I recommend a carbon steel insole/insert but would like to have a winter boot that I can use with or without it. Thanks!

    • Hi Sherry,

      That’s a pretty tall order.

      I have some black, knee high boots on this page, but they’re not necessarily zippered and for sesamoiditis.

      But they might accommodate Tread Labs insoles, which will greatly support you.

      Best I can do!



  2. My altberg boots are suddenly hurting because of sesesamoids. Can you recommend a waterproof boot as I do alot of trecking in challenging weather. I have merrall gortex boots but for wet winder walking they just not enough


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