Sesamoiditis vs. Gout: What Are the Differences?

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Sesamoiditis is an inflammation of sesamoid bones and the tendons of the flexor hallucis brevis at the bottom of the first metatarsal phalangeal joint (first digit joint) of the foot. It is often caused by overuse. It is common in people who bear weight on the balls of their feet, including dancers and runners.

Sesamoiditis is treated with rest, anti-inflammatory pain relievers, methods to offload stress on the foot, and other measures. 

On the other hand, gout is a type of inflammatory arthritis caused by uric acid crystals in affected joints. Gout is related to specific risk factors, including genetics, certain health conditions, and a purine-rich diet. It is managed with medications that relieve symptoms during a gout attack and drugs to prevent future episodes. 

Learn more about the differences between sesamoiditis and gout. Make sure to see a healthcare provider for a diagnosis so that you can receive the proper treatment.

Man in bed feeling toe pain from gout

LightFieldStudios / Getty Images

Symptoms

One of the earliest signs of sesamoiditis is a dull ache under the big toe that builds up and makes walking painful. Gout can also affect the big toe and lead to severe pain in the big toe and the foot. There are additional symptoms that sesamoiditis and gout might have in common, but they are two very different conditions. 

Sesamoiditis
  • Pain under the big toe

  • Difficulty bending the toe

  • Difficulty bearing weight on the foot

  • Pain at the ball of the foot

  • Swelling

  • Bruising and redness

  • Pain with walking

Gout of the Big Toe
  • Intense throbbing of the toe

  • Burning joint pain

  • Red discoloration

  • Stiffness

  • Swelling

  • Tenderness even to light touch

  • Warmth of the affected joint

  • Hard lumps called tophi

Sesamoiditis Symptoms

The sesamoid bones (two pea-shaped bones in the ball of the foot, beneath the big toe joint) of the foot bear the stress of shock absorption from walking. The medial sesamoid bone (closer to the center of the foot) bears most of this stress and is most affected by sesamoiditis. But the tibial sesamoid (closer to the big toe) can also be affected.

Sesamoiditis tends to develop gradually with overuse of the foot. In addition to big toe and foot pain, it also causes:

  • Difficulty bending the big toe
  • Problems bearing weight or walking
  • Swelling, redness, and bruising of the big toe and foot

Gout Symptoms 

The main symptom of gout is a sudden attack of severe pain in one or more joints, usually the big toe.

Additional symptoms of gout include:

  • Intense pain that makes moving the toe and walking difficult
  • A hot and tender joint that cannot bear anything touching it, not even bedding
  • Swelling in and around the affected joint
  • Red, shiny skin at the affected joint
  • Peeling and itching skin as the swelling subsides 
  • Fever if there is an infection present
  • Hard lumps called tophi: Tophi occurs when gout is chronic and will develop in the joints, as well as the skin and soft tissue around those joints. Left untreated, tophi can cause permanent damage.

Causes

The underlying causes of sesamoiditis and gout are very different. Sesamoiditis is caused by overuse and can sometimes come on acutely (suddenly), while gout is related to risk factors such as genetics and diet.

Sesamoiditis

Sesamoiditis occurs from the overuse of the tendons of the sesamoid bones. The tendons can also become inflamed from repeat trauma, such as wearing high-heeled shoes or shoes that fit poorly.

People who engage in sports that put a lot of pressure on the ball of the foot are at a higher risk for sesamoiditis. For example, running, football and soccer are sports commonly associated with sesamoiditis because of overpronation. Ballet dancers are also at an increased risk due to forces placed on their feet while dancing. 

Overpronation

Pronation is when the foot naturally moves side to side during running or dancing. If excessive pronation (overpronation) occurs, the arch flattens more than usual, and the median ankle rotates closer to the ground with a step. There is more pressure and stress on the feet, leading to inflammation and pain.

A high-arched foot can predispose someone to develop sesamoiditis and sesamoid fractures. This happens because there is excess loading (placing of weight) at the base of the foot because of the way the high-arched foot will absorb force with activity.

Gout 

Gout is caused by uric acid crystals that have made their way into the joints. The crystals develop when uric acid (a waste product) builds up in the body. 

Uric acid is created when the body breaks down purines from your diet or recycles aging or damaged cells. When the kidneys do not adequately filter uric acid or too much is produced due to diet or the breakdown of cells, it builds up in the body and turns into tiny crystals.

Uric acid crystals can form in and around the joints. If the crystals get in the spaces between joints or the soft tissue surrounding joints, they can lead to painful inflammation. 

Risk factors linked to gout include:

  • Being male: Females tend to have lower uric acid levels than males
  • Being overweight 
  • Having certain health conditions, including poor kidney function, hypertension (high blood pressure), and congestive heart failure (the heart does not pump enough blood to meet the body's needs)
  • Using certain medications, such as diuretics (water pills)
  • Overconsumption of alcohol
  • Consuming foods and drinks high in fructose corn syrup
  • Eating a diet rich in purines: Purine-rich foods include red meats, organ meats, and some types of seafood, including anchovies and sardines.
  • Genetics: Research on gout shows that genes have a higher impact on the development of gout than your diet. According to a 2018 meta-analysis of genetics and eating habits, genetics accounts for 24% effect on uric acid levels, while diet accounts for 1%. 

Diagnosis 

For both sesamoiditis and gout, healthcare providers use testing methods to aid in diagnosis. Diagnosis for both conditions involves discussing symptoms and medical history, a physical examination, imaging, and lab testing to rule out other conditions and similar diseases. 

Sesamoiditis 

When diagnosing sesamoiditis, a healthcare provider will ask you when the foot and toe pain started. They will check the ball of the foot and toe for tenderness and test your range of motion in the toe.

Imaging might be requested to look for stress fractures (bone cracks) or to rule out or confirm other conditions that might cause similar symptoms. Imaging might include X-rays, computed tomography (CT) scans, ultrasound, or magnetic resonance imaging (MRI).

Gout 

A healthcare provider might suspect gout based on your symptoms. They will ask what symptoms you have experienced and have questions about your medical history. You will also be asked about your diet, especially alcohol, sugar, and purine intake. They will also examine the affected foot and toe. 

Because other conditions can affect the feet, the healthcare provider might request additional testing. These tests will either confirm gout or rule out other conditions. Testing might include:

  • Joint fluid test: A joint fluid test involves taking a fluid sample from the affected joint to check for abnormalities, including uric acid crystals.
  • Serum uric acid test: This blood test measures the amount of blood uric acid. High levels of uric acid are often linked to gout.
  • Imaging: X-rays can rule out or confirm other conditions that cause similar symptoms to gout, and can show long-term bone damage from gout. Ultrasound scans (which use sound waves to produce images) are sensitive enough to detect crystals in the joints and deep into the skin tissue.

Treatment 

Some of the same therapies used to treat sesamoiditis are also used to treat gout. In addition, gout is also treated with medications to prevent future flares. 

Sesamoiditis

Sesamoiditis is a repetitive stress injury, so treatment starts with rest and activity restriction. You will need to keep pressure off the foot until symptoms improve. Your healthcare provider might tape the big toe so it is bent slightly downward.

You may need a felt cushioning pad in your shoe to relieve pressure. Strapping and offloading weight bearing, wearing a controlled ankle motion (CAM) walking boot, or removable short leg brace might also be recommended.

Icing and elevating the foot can help reduce inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) can bring down inflammation and reduce pain. 

Your healthcare provider might recommend physical therapy or soft tissue therapy. Physical therapy can help restore your motion in the affected areas of your foot. Therapeutic ultrasound (soft tissue therapy) uses heat or soft tissue massage to rehabilitate the affected tissues.

A steroid injection might be given directly into the injured tissue to relieve pain and inflammation for severe sesamoiditis.

In rare instances where sesamoiditis is chronic, surgery might be necessary. Surgery may involve shaving or removing the sesamoid bones to bring relief.

Gout

Treatment for gout focuses on pain and symptom relief and preventing future gout attacks. 

Medications that improve pain and symptoms during a gout flare include NSAIDs, corticosteroids (oral or injection), and Colcrys (colchicine).

Medicines that lower uric acid levels can prevent future gout attacks. Such medications include oral Zyloprim (allopurinol), Probalan (probenecid), or Uloric (febuxostat). The intravenous infusion Krystexxa (pegloticase) is used for multiple joint involvement and large tophi removal to disintegrate the tophi.

Gout is also managed with weight loss, physical therapy, and diet changes. 

Prevention 

Some risk factors for sesamoiditis and gout might be out of your control. Others, like diet changes, weight loss, and injury prevention, might help you reduce your risk for one or both of these conditions.

Sesamoiditis 

While sesamoiditis isn’t always preventable, there are ways to reduce your risk.:

  • Wear comfortable shoes: The easiest and most effective way to prevent sesamoiditis is to wear proper fitting shoes. Sneakers are an ideal option for people at risk for sesamoiditis. Conservative management of the condition typically includes shoes with lower heels and padding. Choose shoes that absorb shock, offer support and cushion, and have enough room for bone, muscle, and tendon alignment. 
  • Use orthotics: If you have high arches or participate in activities that increase your risk for sesamoiditis, orthotics might help protect your sesamoid bones. They can be purchased over-the-counter (OTC), or you can make an appointment with a podiatrist (a specialist in foot and ankle care) who can prescribe a custom pair. The best orthotics distribute weight and restrict motion of the metatarsophalangeal joint of the big toe. When sesamoiditis exists, orthotics might help decrease inflammation. 
  • Control your pronation: You might be able to control your pronation by changing your workout shoes or using an orthotic. Your healthcare provider or a physical therapist can discuss how you can avoid overpronation by strengthening and stretching the legs and feet before activities that stress the sesamoid bones.

Gout 

Some risk factors for gout, including diet, alcohol consumption, and obesity, might be vital in preventing gout. For example, a 2020 study of men with gout found more than three-quarters of gout cases might be preventable.

That study found that gout might be prevented by combining a DASH-style diet (a diet with plenty of vegetables, fruits, low-fat dairy products, whole grains, fish, poultry, and nuts), no alcohol intake, and no diuretic use in men at an average weight.

But among men with obesity, the researchers noted there would be no benefit until weight modifications are addressed.

Summary 

Sesamoiditis and gout can affect the bones, joints, tendons, and other tissues of the big toe and foot. While they share some similar symptoms, they are two very different conditions. Sesamoiditis is an overuse injury, while gout is an inflammatory condition linked to genetics, diet, and other risk factors.

You can manage symptoms of both conditions with NSAIDs, rest, elevation, and icing to alleviate pain and reduce inflammation. Sesamoiditis is also treated with soft tissue therapy, physical therapy, and steroid injections with surgery as a last resort.

Gout treatment focuses on symptom relief and preventing future attacks with colchicine, corticosteroids, and medicines to reduce uric acid in the body. It is also managed with diet changes, physical therapy, and weight loss. 

A Word From Verywell

There are a variety of conditions that affect the foot and the big toe. With early diagnosis, most can be treated without surgery, allowing you to return to your usual quality of life as quickly as possible.

Conditions that affect the feet and toes might include inflammatory arthritis, plantar plate problems, tarsal tunnel syndrome, and more. You should reach out to your healthcare provider if you experience foot or toe pain with swelling, tenderness, redness, and warmth that lasts more than a few days. 

Frequently Asked Questions

  • Can gout affect the sesamoid bone?

    Gout is caused by a buildup of uric acid in the body crystalizing in and around a joint, while sesamoiditis results from overuse. An injury or inflammatory cause like sesamoiditis might trigger a gout attack, and while rare, a gout attack could occur from a stress injury of the sesamoid bone. 

  • How do you know if you have sesamoiditis?

    The symptoms of sesamoiditis are gradual. One of the earliest signs of the condition is a dull ache under the big toe. That ache will build up until walking becomes painful. Additional symptoms include difficulty bending the big toe and problems bearing weight on the foot and big toe. 

  • What does it mean to have a break in the sesamoid bone?

    A break (fracture) can occur due to a direct blow or trauma to the bone. A fracture will produce immediate pain and swelling at the affected bone but will not affect the entire toe joint. 

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons. Sesamodiditis.

  2. American Academy of Orthopaedic Surgeons. Gout.

  3. Verma S, Bhargav P, Toprani T, Shah V. Multiarticular tophaceous gout with severe joint destruction: a pictorial overview with a twistIndian J Dermatol. 2014;59(6):609-611. doi:10.4103/0019-5154.143538

  4. Stracciolini A, Dahlberg BW, Quinn B, Sugimoto D, Stein C. Sesamoid injuries in pediatric and adolescent athletes presenting to sports medicine clinicOrthop J Sports Med. 2019;7(3 Suppl):2325967119S00183. doi:10.1177/2325967119S00183

  5. Sims AL, Kurup HV. Painful sesamoid of the great toeWorld J Orthop. 2014;5(2):146-150. doi:10.5312/wjo.v5.i2.146

  6. University of Rochester Medical Center. Uric acid (blood).

  7. Centers for Disease Control and Prevention. Gout.

  8. Evans PL, Prior JA, Belcher J, Hay CA, Mallen CD, Roddy E. Gender-specific risk factors for gout: a systematic review of cohort studiesAdv Rheumatol. 2019;59(1):24. doi:10.1186/s42358-019-0067-7

  9. Major TJ, Topless RK, Dalbeth N, Merriman TR. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ. 2018;363:k3951. doi:10.1136/bmj.k3951 

  10. Girish G, Melville DM, Kaeley GS, et al. Imaging appearances in goutArthritis. 2013;2013:673401. doi:10.1155/2013/673401

  11. Atiya S, Quah C, Pillai A. Sesamoiditis of the metatarsophalangeal joint. OA Orthopaedics. 2013;1(2):19. doi:10.13172/2052-9627-1-2-786

  12. McCormick N, Rai SK, Lu N, Yokose C, Curhan GC, Choi HK. Estimation of primary prevention of gout in men through modification of obesity and other key lifestyle factorsJAMA Netw Open. 2020;3(11):e2027421. doi:10.1001/jamanetworkopen.2020.27421

By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.