Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
Watch: Dr. Tom Biernacki, DPM
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: April 4, 2026
QUICK ANSWER
A sesamoid fracture is a break in one of the two small bones under the big toe joint, causing forefoot pain with walking and toe extension. Most acute fractures heal with 6-8 weeks of immobilization and offloading; chronic non-union may require shockwave therapy, orthotics, or surgical removal of the fractured sesamoid.
What Are the Sesamoid Bones?
The sesamoid bones are two small, pea-shaped bones embedded within the flexor hallucis brevis tendon on the plantar (bottom) surface of the first metatarsal head — directly beneath the big toe knuckle joint. They function as a pulley for the flexor tendons, increasing their mechanical advantage for plantarflexion of the big toe during push-off, and as a weight-bearing cushion beneath the first metatarsal head. The medial (tibial) sesamoid is slightly larger and bears more weight; the lateral (fibular) sesamoid is smaller and positioned beneath the lateral surface of the metatarsal head.
At Balance Foot & Ankle, we diagnose and treat sesamoid fractures and sesamoiditis in athletes and active patients throughout Southeast Michigan, providing both conservative management and surgical consultation when needed.
How Sesamoid Fractures Occur
Sesamoid fractures can be either acute or stress fractures. Acute sesamoid fractures result from a direct blow or sudden forceful plantarflexion — such as a landing from height that hyperextends the big toe — that applies more force to the sesamoid than the bone can withstand. Stress fractures of the sesamoid are far more common and occur from repetitive loading that cyclically stresses the sesamoid beyond its healing capacity. Runners, ballet dancers, basketball players, and other athletes who perform repetitive forefoot loading on hard surfaces are at highest risk for sesamoid stress fractures.
A confounding factor in sesamoid diagnosis is the bipartite sesamoid — a sesamoid that naturally develops from two ossification centers and remains in two separate parts in approximately 10 to 30 percent of people. Bipartite sesamoids are bilateral in 25 percent of cases and can be misidentified as fractures. Smooth, rounded edges on imaging suggest a bipartite sesamoid; sharp, irregular edges suggest acute fracture. Bone marrow edema on MRI differentiates symptomatic bipartite sesamoid from asymptomatic bilateral variant.
Symptoms and Diagnosis
Pain directly beneath the first metatarsal head at the sesamoid region is the hallmark symptom. The pain is worse with weight bearing and with push-off during walking and running, and is detailedly tender with direct palpation from the plantar surface of the foot. Ballet dancers and runners describe progressive forefoot pain that initially limits certain positions and progressively limits all activity. Swelling and bruising beneath the metatarsal head may be present with acute fractures.
Weight-bearing X-rays in multiple views are the first imaging step. MRI is the gold standard for confirming sesamoid stress fracture, evaluating fracture extent, excluding bipartite sesamoid confusion, and assessing avascular necrosis in delayed presentations.
Conservative Treatment
Non-displaced sesamoid fractures are managed conservatively for 6 to 12 weeks. A CAM boot or rigid-soled shoe eliminates the sesamoid loading of normal gait. A sesamoid offloading orthotic with a dancer pad — a donut-shaped pad around the sesamoid — redistributes pressure away from the fracture zone. Complete avoidance of barefoot walking, push-off activities, and first MTP joint hyperextension is essential during healing. Recovery is frustratingly slow — the poor blood supply of the sesamoid slows healing significantly compared to most other foot bones.
When Surgery Is Considered
Surgical options for sesamoid fractures include excision of the involved sesamoid for fractures that fail to heal after prolonged conservative management. Sesamoid excision reliably relieves pain and allows return to activity, though it requires careful technique to avoid altering hallux alignment or weakening flexor tendon function. Most surgeons prefer conservative management exhausted over 4 to 6 months before recommending excision.
If you have persistent big toe joint pain beneath the ball of the foot, contact Balance Foot & Ankle for evaluation. We serve Southeast Michigan with same-week appointments.
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Board-certified podiatrists serving Southeast Michigan. Same-week appointments available.
Warning
Sesamoid stress fractures are often misdiagnosed as turf toe or sesamoiditis. MRI is essential for accurate diagnosis—delayed treatment can lead to chronic non-union or avascular necrosis requiring sesamoidectomy.
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When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Township clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Township
Frequently Asked Questions
How is a sesamoid fracture diagnosed?
Diagnosis combines clinical examination with X-rays and MRI. MRI is particularly useful to distinguish fracture from sesamoiditis, stress reaction, or avascular necrosis. Ultrasound can also identify soft tissue involvement.
How long does a sesamoid fracture take to heal?
Acute fractures typically heal in 6-8 weeks with immobilization, offloading, and activity modification. Stress fractures may take 12 weeks or longer. Non-unions can persist indefinitely without intervention.
Will I need surgery for a sesamoid fracture?
Most sesamoid fractures heal without surgery. Sesamoidectomy is reserved for non-unions, avascular necrosis, or chronic pain that fails conservative care. Removing only one sesamoid preserves most big toe function.
Suspect a Sesamoid Injury?
Our sports medicine foot specialists diagnose sesamoid fractures accurately and offer both conservative and surgical treatment based on your injury severity.
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Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Township Office
43494 Woodward Ave, Suite 208
Bloomfield Township, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMost Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Township offices.
More Sesamoiditis Guides from Dr. Tom
Need treatment? Learn about in-office sesamoiditis treatment at Balance Foot & Ankle, or call (810) 206-1402 for same-day appointments.
