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Sesamoiditis: Toe Pain that Pulls You Down

Sesamoiditis painCan you lift a grand piano? Probably not, but with pulleys you can! Pulleys are wheels or a group of wheels that—when you loop rope around them—make lifting things easier. They multiply the amount of force your body can produce. The same is true for sesamoid bones at the base of your big toe. These two small bones, implanted in the tendons, act as wheels and the tendons act as rope. As you push off, the bones give the tendons more leverage to transmit muscle forces that move your feet. When these bones become aggravated, you might have toe pain that stems from a condition called sesamoiditis.

Two Tiny Bones that Carry Mighty Pain

Inside the tendons underneath the first metatarsal bone lie two small bones that are about the size of a pea. These are called sesamoids. They’re unique in the fact that they aren’t connected to other bones. One sits on the inner side of the metatarsal and one bone rests more toward the middle of the foot on the other side of the metatarsal. Because they’re located within the tendon, the irritation from the bones also transmits to the tendons. This makes the condition also a form of tendinitis.  

How Do I Know I Have This?  

This condition usually appears gradually from an increase in activity, with the pain mostly located in the base of the big toe, on the ball of the foot. The only way the injury is sudden is if there’s a fracture present. There typically isn’t any bruising or redness, but there is a small aching at first. It can get worse if you continue to repeat the activity that irritates the area, including an increase in running miles, hill training, or speed work. Toe pain from this condition is also common in baseball catchers, who are always crouching, and in ballet dancers who must use their toes to push off of the ground often.

Other times, sesamoiditis can be caused by nothing other than your foot structure. You might have high arches that put more pressure on the balls of your feet. If you’re older, you might have less natural fatty padding on the bottom of your forefoot, which normally cushions your bones and tendons.

How We Diagnose

To diagnose your condition, we will likely feel around your toe to detect if there is any tenderness in the area of your sesamoid bones. We’ll ask you to bend or straighten your toe, which might prove to be pretty difficult. If you feel pain that intensifies by bending the front of your toe toward the top of your foot, chances are you have this condition.

Restore Your Toe to Full Force!

Initially, you will want to stop all activities that cause pain. We suggest that you rest and ice the area. You may need oral anti-inflammatory medications to relieve discomfort. Orthotics and shoe padding can help to cushion the space under your big toe joint. In our office, we can also show you how to tape your toe to keep the area stiff and void of movement.

During recovery, please wear stiff shoes with soft soles and low heels to avoid aggravating the area. If you follow the care instructions correctly, you might heal faster than originally planned! In severe cases where your bone is fractured or your toe pain isn’t responding to conservative treatment, we might suggest surgery.

Don’t let your toe pain keep you down! You can trust that our recommendations for care and treatment comes from years of experience in podiatry. Call the McDowell Podiatry Group in Carmichael, CA, at (916) 961-3434 to make an appointment. Our office can also be reached on Facebook, Twitter, and Pinterest!