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The sesamoids are types of accessory bone that sit under the big toe joint. If your foot is not functioning optimally, then your sesamoids may become bruised and inflamed. This is also a common issue for patients with high arched feet. 

A man grips his right forefoot with both hands, while the forefoot is coloured red to indicate a painful area.

About Sesamoiditis

The sesamoids help to improve the function of the big toe joint, and give the flexor tendons a mechanical advantage. The kneecaps do the same, and you can see them in action at this really awesome YouTube video

Because of their size, and their position, they take quite a lot of impact and this leaves them vulnerable to becoming inflamed, especially in feet that aren't functioning optimally.


Symptoms of Sesamoiditis

Symptoms of  sesamoiditis are typically a very localised feeling of:

  • Bruising

  • Aching

  • Swelling

  • A feeling like there's a lump under the ball of the foot

And this will be localised to the sesamoid region, 

It will typically get more painful as the day progresses and worse with movement.


Likewise, it will respond well to days where you do less.

A barefooted man is about to step on a marble.

What else could it be?

If pain is localised to the region of the sesamoids, then the likely diagnoses are:

  • Sesamoid fracture

  • Avascular necrosis

  • Bursitis

How is Sesamoiditis diagnosed?

All diagnoses start with the taking of a clinical history and physical examination. Depending on

  • how the problem started

  • the patient's age

  • severity of symptoms

  • duration of symptoms

​will determine whether or not imaging is needed to rule out other diagnoses. 

Imaging used to confirm sesamoiditis:

  • MRI Scans (may often miss neuromas if 'slices' taken are too widely spaced.

  • X-rays can be used, however, very specific 'views' are needed and failures to get the correct view will mean the X-ray results are redundant. 

  • Ultrasound can be useful if performed by someone experienced with foot and ankle ultrasound. 

A sagittal plane view of an MRI of the foot and ankle. This is a great modality for identifying different sesamoid pathologies.
A podiatrist about to give an injection into the bottom of the foot.

How is Sesamoiditis treated?

Sesamoiditis is treated by 'offloading' the sesamoids and transferring weight to the rest of the foot and surrounding structures with the goal being to reduce the inflammation.

This can be achieved a number of ways, in particular:

  • Stretching the calf muscles

  • Changing footwear

  • Use of anti-inflammatories

  • Orthotics and insoles

  • Manipulation and mobilisation of joints

  • Shockwave therapy

  • Steroid injections

Ready to start being pain free?

How long does it take to cure Sesamoiditis?

Sesamoiditis is bruising of the bones, and depending on the severity, can take anything from a few days to settle, up to 6 weeks, if a treatment plan is carefully followed. 

You can imagine however that it is difficult to protect the sesamoids fully without it significantly impacting your day-to-day life and, as a result, it may take longer than the timeframe stated above for the symptoms to settle fully. 

A man running with his dog.
Ready to say goodbye to your pain?

At Keep On Your Feet, we openly acknowledge that we cannot guarantee a cure for things: but we will work as hard as we can with you to help you reach your goals. 

If your symptoms fit the above, you will need to book a 'Foot Pain' consultation. This will be £95 and lasts approximately 60 minutes usually. If you need insoles, we'll give you some basic ones to try out (or some fancier ones and reduce their price!). 

This is a picture of Jeremy Ousey, director and podiatrist of Keep On Your Feet.

About the Author

Jeremy Ousey is the owner at Swansea's podiatry clinic: Keep On Your Feet. All the information found on this page was written by him (there's no AI or Chat-GPT here!), and has been carefully chosen to provide you with the information that you need to know about the condition. Jeremy has a Bachelor of Science in Podiatry, with honours, a Post-Graduate Certificate in Podiatric Sports Medicine, a Post-Graduate Diploma in Medical Ultrasound, and two Master's of Science degrees in the Theory of Podiatric Surgery, and Sports & Exercise Medicine. If you would like to know more about Jeremy, please click here.

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