Sesamoiditis is a painful condition that affects the ball of the foot, usually under the big toe joint. It happens when the small sesamoid bones and nearby tendons become irritated from repeated pressure or overuse.

The sesamoids are two small bones located beneath the big toe joint. They help absorb pressure, support movement, and assist with push-off when walking, running, or jumping. When these bones become inflamed or irritated, each step can become painful.

At Orange County Foot & Ankle Institute, Dr. Amir Lebaschi, DPM evaluates pain under the big toe joint carefully to determine whether sesamoiditis, a fracture, arthritis, tendon injury, or another condition may be causing the problem.

What Causes Sesamoiditis?

Sesamoiditis usually develops from repeated stress on the ball of the foot. It is common in people who place frequent pressure on the big toe joint.

Common causes and risk factors include:

• Running or jumping activities
• Dancing or sports that require push-off
• High-impact exercise
• Wearing high heels
• Shoes with poor cushioning
• Walking barefoot on hard surfaces
• High arches
• Repeated pressure under the big toe
• Sudden increase in activity
• Foot structure or biomechanical imbalance

AAOS explains that the sesamoids help with weight bearing and assist the tendons that bend the big toe downward. Repeated stress can irritate the area and cause pain.

Common Symptoms

Sesamoiditis often causes pain under the big toe joint or in the ball of the foot. The pain may start gradually and become worse with activity

Symptoms may include:

• Pain under the big toe joint
• Pain in the ball of the foot
• Swelling or tenderness
• Pain when pushing off while walking
• Pain with running, jumping, or dancing
• Discomfort when wearing high heels or thin shoes
• Difficulty bending or straightening the big toe
• Pain that improves with rest but returns with activity

sesamoiditis as a common cause of pain in the ball of the foot and notes that waiting too long to treat it can contribute to longer-term problems.

Why Sesamoiditis Should Not Be Ignored

Pain under the big toe joint can affect how a person walks. To avoid pain, a patient may shift weight to the outside of the foot or change their gait. Over time, this can create strain in other areas of the foot, ankle, knee, or leg.

Sesamoid pain can also be confused with other conditions, such as a sesamoid fracture, turf toe, arthritis, tendon injury, or nerve irritation. A proper evaluation helps identify the true cause and guide treatment.

Ignoring the pain or continuing high-impact activity may make the irritation worse and delay recovery.

How Sesamoiditis Is Diagnosed

A podiatric evaluation may include a physical exam, symptom review, activity history, footwear review, and assessment of foot mechanics.

Dr. Amir Lebaschi, DPM may check for tenderness under the big toe joint, swelling, range of motion, pressure points, and pain with push-off.

Imaging may also be needed. X-rays can help check for fracture, bone position, arthritis, or other structural problems. In some cases, additional imaging may be recommended if symptoms persist or the diagnosis is unclear.

Treatment for Sesamoiditis

Treatment usually begins with conservative care. The goal is to reduce pressure, calm inflammation, and protect the sesamoid area while it heals.

Treatment may include:

• Rest from painful activities
• Ice therapy
• Activity modification
• Supportive shoes with cushioning
• Avoiding high heels or thin-soled shoes
• Padding to offload the sesamoids
• Custom orthotics
• Taping or immobilization
• Anti-inflammatory medication when appropriate
• Physical therapy or stretching
• Temporary walking boot when symptoms are more severe

sesamoiditis treatment usually does not require surgery and often begins with stopping the activity that causes pain, shoe changes, padding, and other conservative measures.

When Surgery May Be Considered

Most cases of sesamoiditis improve without surgery. However, surgery may be considered if pain continues despite proper conservative treatment, or if there is a fracture, bone damage, or another structural issue that does not improve.

Surgery is not the first step for most patients. Because the sesamoids help with foot mechanics and push-off, treatment decisions should be made carefully.

AAOS notes that surgery to remove a sesamoid bone may be considered when conservative treatment does not relieve symptoms.

How to Help Prevent Sesamoid Pain

Prevention focuses on reducing repeated stress under the big toe joint

Helpful steps may include:

• Wearing supportive shoes with good cushioning
• Avoiding long periods in high heels
• Increasing activity gradually
• Stretching the calves and feet
• Using orthotics if foot mechanics increase pressure
• Avoiding barefoot walking on hard surfaces
• Resting when pain first appears
• Replacing worn-out shoes

Athletes, dancers, and active patients should pay attention to early pain under the big toe joint before it becomes chronic.

When to See a Podiatrist

You should schedule an evaluation if you have:

• Pain under the big toe joint
• Pain in the ball of the foot
• Swelling or tenderness near the big toe
• Pain that worsens with walking or push-off
• Difficulty bending the big toe
• .Pain after running, jumping, or sports
• Symptoms that do not improve with rest
• Pain that changes the way you walk

Seek care sooner if there is severe pain, bruising, inability to bear weight, or concern for a fracture.

The Bottom Line

Sesamoiditis is a common cause of pain under the big toe joint. It often develops from repeated pressure, overuse, poor footwear, or foot mechanics that overload the ball of the foot.

At Orange County Foot & Ankle Institute, Dr. Amir Lebaschi, DPM evaluates sesamoid pain carefully and creates treatment plans to reduce pressure, relieve pain, and support safe healing. If pain under the big toe joint is affecting walking, sports, or daily comfort, early podiatric care can help prevent the problem from becoming chronic.