Foot Health Print Sesamoiditis and Big Toe Pain Medically reviewed by Medically reviewed by Casey Gallagher, MD on November 10, 2019 Casey Gallagher, MD is board-certified in dermatology and works as a practicing dermatologist and clinical professor. Learn about our Medical Review Board Casey Gallagher, MD Written by twitter linkedin Written by Jonathan Cluett, MD Dr. Jonathan Cluett is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Learn about our editorial policy Jonathan Cluett, MD Updated on November 15, 2019 bgwalker / Getty Images More in Foot Health Healthy Foot Care Bunions Joint & Ligament Issues Skin Problems Heel Pain Toenail Problems Most of us have two bones, called sesamoid bones, under the joint at the base of the big toes. In rare instances, people may be missing one or both of these bones. These sesamoid bones are actually enveloped within the tendons under the big toe. When these bones become inflamed, the condition is called sesamoiditis. Sesamoiditis can be caused by acute injury or chronic overuse. Sesamoid pain can also be caused by stress fractures of the sesamoid, or a condition called osteonecrosis. Less common causes of sesamoiditis include infection or systemic disorders such as autoimmune diseases. People with chronic sesamoid pain should be evaluated for these conditions. Overuse Injuries Symptoms Sesamoid problems are usually detectable by a careful history and examination. The most common symptoms include: Pain with weight-bearingPain with pressure applied directly to the sesamoid bonesPain when the great toe is forcefully pulled upwards (dorsiflexion of the great toe) Other conditions that can cause similar symptoms include hallux rigidus and gout. Diagnosis can be confirmed with imaging tests. X-rays can be helpful, especially if a fracture of the sesamoid bone is suspected. However, sometimes the small sesamoid bones are difficult to adequately visualize on an x-ray test, and therefore other tests may also be considered. The most commonly used test is an MRI study, but bone scans can also be effective to identify sesamoid problems. Treatment The treatment of sesamoiditis begins with altering footwear. Increasing the amount of cushioning within your shoes can help relieve pressure on the affected sesamoid. Specific inserts or custom orthotics can also be used to try to shift forces away from the inflamed bone. Other treatments include resting, avoiding specific activities that irritate the bone, non-steroidal anti-inflammatory medications, and ice application. Recovery from a sesamoid injury can take months and is often a frustrating experience. Athletes may require a prolonged period of restricted weight-bearing or mobility, and often recovery to full sports activities can take 3 to 6 months. In the unusual circumstance that footwear modifications and rest are insufficient to relieve the discomfort, there are surgical treatment options. However, these surgical procedures should be approached cautiously, as deformities of the big toe can often result if one or both of the sesamoid bones are removed. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Sims AL, Kurup HV. Painful sesamoid of the great toe. World J Orthop. 2014;5(2):146-50. doi:10.5312/wjo.v5.i2.146 Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging. 2013;4(5):581-93. doi:10.1007%2Fs13244-013-0277-1 Centers for Disease Control. Gout. Updated January 28, 2019 Additional Reading Richardson EG. "Hallucal sesamoid pain: causes and surgical treatment" J. Am. Acad. Ortho. Surg., Jul 1999; 7: 270 - 278. Continue Reading