What Is Sesamoiditis?
Sesamoiditis is a condition that causes pain in the forefoot, specifically under the big toe joint. The sesamoids are two small bones located inside the tendon that runs under the big toe. They function as a pulley, increasing the leverage of this tendon during push-off when walking, running or jumping.
The sesamoids can become inflamed and, in some cases, fractured or necrotic (death of bone tissue) due to excessive pressure placed on them. Sesamoiditis is commonly seen in dancers (particularly those performing demi-pointe work) but also affects runners, basketballers, netballers and anyone whose activity involves repeated load through the ball of the foot.
What Causes Sesamoiditis?
Common causes and risk factors include:
- High-arched foot type — less contact area between the foot and ground increases pressure on the sesamoids
- Pronation (rolling in of the feet) — causes the sesamoids to rotate, leading to irritation over time
- Bony foot type — minimal fatty padding under the ball of the foot reduces natural cushioning
- Footwear with reduced padding — particularly minimalist shoes, ballet shoes or worn-out trainers
- Increased activity load — sudden increases in running mileage, dance hours, or jumping sports
- Repetitive demi-pointe work in ballet and dance disciplines
What are the Symptoms of Sesamoiditis?
- Gradual onset — pain usually begins as a mild ache and increases gradually as the aggravating activity continues
- Pain under the big toe joint — localised to the ball of the foot on the inside (medial sesamoid) or outside (lateral sesamoid)
- Limited skin changes — redness or bruising is rarely seen
- Reduced dorsiflexion of the big toe (limited ability to bend the toe upward)
- Pain when rising onto the ball of the foot — particularly noticeable when walking on tiptoes, pushing off during running or performing dance movements
- Pain when walking barefoot on hard surfaces
What Treatment is Available?
Our podiatrists tailor sesamoiditis treatment to the severity of the condition and the patient’s activity demands. Options include:
- Taping and padding — strategic taping of the big toe and padding around the sesamoid bones reduces pressure on impact and is often the first-line intervention
- Activity modification — altering training, technique or dance work to reduce load on the sesamoids while they recover. In dancers, this often involves modifying or temporarily ceasing demi-pointe work
- Footwear modifications — switching to shoes with thicker, cushioned soles and a wider toe box to offload the sesamoids
- Custom orthotics — with a sesamoid cut-out or “dancer’s pad” built in to offload the affected bone while supporting the foot’s mechanics
- Soft tissue therapy — to address muscle tightness around the big toe joint contributing to load patterns
- Medical Imaging — where a sesamoid fracture or necrosis is suspected, MRI or bone scan can confirm the diagnosis
- Immobilisation — in more severe cases, a stiff-soled shoe or moon boot may be required to allow the sesamoids to heal
- Surgical referral — in rare, persistent cases that haven’t responded to conservative treatment, surgery to remove the affected sesamoid bone may be required. This is reserved for severe presentations
Most cases of sesamoiditis resolve within six to twelve weeks with appropriate management.
Why Choose Highett Podiatry?
Sesamoiditis is one of the most common dance-related foot conditions we treat and our clinic has long-standing relationships with dance schools across Melbourne.
Our podiatry team includes practitioners with a special interest in dance podiatry, and we understand the demands placed on the feet in ballet, contemporary, and other dance disciplines. We also see sesamoiditis frequently in runners and ball-sport athletes. Our approach is tailored to your activity, not generic advice.
We offer appointments at our Highett and Mentone clinics. No referral required.