Pain under the ball of the big toe?

What is Sesamoiditis? 
“Pain under the ball of the big toe” 

Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. These are called the Sesamoids. The kneecap (patella) is the largest Sesamoid. Two other very small Sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe, one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The Sesamoids in the forefoot also assist with weight bearing and help elevate the bones of the big toe. 

  • Pain is focused under the big toe on the ball of the foot.
  • With Sesamoiditis, pain may develop gradually.
  • With a fracture, pain will be immediate.
  • Swelling and bruising may or may not be present.
  • You may experience difficulty and pain in bending and straightening the big toe.

Sesamoid pain can develop in a number of different ways.

Abnormal position of the Big toe joint can result in it’s overloading and like other bones, the Sesamoids underneath the big toe can break (fracture). Fractures can also cause pain in the Sesamoids.

Fractures can occur when a person falls and lands bluntly on the ball of the foot. Stress fractures can also occur in the Sesamoid bones. Stress fractures are usually caused by the strain of overworking the soft tissues. Athletes most often suffer stress fractures of the sesamoids because of the heavy and repeated demands that training places on the soft tissues of the foot and big toe.

Additionally, the tendons surrounding the Sesamoids can become irritated or inflamed. When the tissues around the sesamoid bones become inflamed, doctors call the condition sesamoiditis. Sesamoiditis is often caused by doing the same types of toe movements over and over again, which happens in activities like running and dancing.

Arthritis can develop where the sesamoids glide under the bone of the big toe. The sesamoid bones create a joint where they move against the bone of the big toe. Like other joints in the body, this joint can also develop arthritis. Arthritis is more likely to be a problem in people who have high arches in their feet. The high arch causes the main joint of the big toe to become rigid. This focuses strain and pressure on the sesamoids.

In some cases, blood supply to the sesamoid bone is decreased. This condition is called osteochondritis.  Osteochondritis causes a piece of the bone to actually die. The body's attempts to heal the area may build up extra calcium around the dead spot.

Stop the activity causing the pain.

  • Return to activity gradually, and avoid activities that put your weight on the balls of the feet.
  • Cushioning pads can be helpful as the fracture heals.

If conservative treatment fails you will need to consult Mr Edwards who will be able to help.

The human foot is a miracle of engineering and can normally cope with most of the stresses we throw at it, choose appropriate footwear for your activity and your Sesamoids should hopefully remain symptom free. 

For further advice or to make an appointment, please contact one of our professional team, our numbers and contact details are listed on the Contact page.