Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
What Is Sesamoiditis? For specialized treatment, see our sesamoiditis treatment Michigan.
Sesamoiditis is inflammation of the sesamoid bones and surrounding tendons at the plantar (bottom) surface of the first metatarsophalangeal (MTP) joint—the ball of the foot beneath the big toe. The sesamoids are two small pea-shaped bones embedded within the flexor hallucis brevis tendon. They function like pulleys, increasing the mechanical advantage of the tendon that flexes the big toe and absorbing the substantial forces transmitted through the ball of the foot during push-off. When subjected to repetitive loading, these bones and their surrounding soft tissue become inflamed, producing pain directly beneath the first metatarsal head.
Sesamoiditis is a repetitive stress injury distinct from sesamoid fracture (stress fracture or acute fracture), though the two conditions overlap. It is most common in runners, dancers (especially ballet), athletes who perform jumping or sprinting (basketball, tennis, football), and individuals who spend prolonged time on their feet on hard surfaces. High-heel wearers and people with high-arched feet (pes cavus) are also at increased risk due to increased forefoot loading.
Treatment at Balance Foot & Ankle: Bunion Treatment Options →
Symptoms and Diagnosis
The hallmark symptom is pain directly under the first metatarsal head (the ball of the foot at the base of the big toe), worsened by walking barefoot on hard surfaces, toe-off during running, dancing on pointe, squatting, or any activity requiring forefoot loading. The area is tender to direct palpation of the sesamoids. Swelling and mild bruising may be present. Pain onset is typically gradual with repetitive activity, though an acute exacerbation can occur from a single impact.
Diagnosis requires distinguishing sesamoiditis from sesamoid fracture—both produce the same location of pain, but fracture requires different management. Weight-bearing X-rays may show a bipartite sesamoid (a normal developmental variant where one sesamoid has two parts, present in 10–30% of people) that can be confused for fracture. MRI is the gold standard for evaluating sesamoid integrity, bone marrow edema (stress reaction), fracture, and avascular necrosis, and is often essential for accurate diagnosis and treatment planning.
Treatment
Conservative treatment of sesamoiditis focuses on activity modification and offloading the sesamoids. The first step is reducing or eliminating the provocative activity—runners should reduce mileage; dancers should avoid pointe work during the acute phase. Stiff-soled footwear with a rocker sole reduces sesamoid loading during gait. A sesamoid pad (dancer’s pad) made of felt or silicone can be placed in the shoe to redistribute pressure away from the first metatarsal head, providing immediate symptomatic relief. Custom orthotics with a Morton’s extension and sesamoid offloading are the most effective long-term mechanical solution.
Ice, NSAIDs, and relative rest help manage acute inflammation. A corticosteroid injection into the first MTP joint or adjacent to the sesamoid can provide significant relief in refractory cases. If a sesamoid stress fracture or avascular necrosis is identified on MRI, a period of non-weight-bearing immobilization in a CAM boot or cast (6–8 weeks) is required. Most cases of sesamoiditis resolve with conservative treatment over 6–12 weeks. Surgical sesamoidectomy (removal of the affected sesamoid) is reserved for cases that fail extended conservative treatment—typically 6–12 months—and produces good outcomes in appropriately selected patients.
Frequently Asked Questions
How long does sesamoiditis take to heal?
Most cases of sesamoiditis (without fracture) resolve in 6–12 weeks with consistent conservative treatment: activity modification, sesamoid offloading with padding and orthotics, and relative rest from high-impact activities. Athletes who try to push through the pain without modification significantly prolong recovery. If a sesamoid stress fracture is present, healing requires 8–12 weeks of non-weight-bearing or partial weight-bearing in a boot. Avascular necrosis of the sesamoid has the longest and most unpredictable course. Returning to high-impact sport (running, dancing) too early is the most common reason for prolonged sesamoiditis. A graduated return-to-sport program after pain resolution reduces the risk of recurrence.
Can I run with sesamoiditis?
Running with active sesamoiditis is generally not recommended as it perpetuates the inflammatory cycle and delays healing. Continued forefoot impact loading prevents resolution. However, the degree of activity modification needed depends on symptom severity: severe sesamoiditis may require complete rest from running for 4–8 weeks; milder cases may tolerate low-impact cross-training (swimming, cycling, pool running) that unloads the forefoot while maintaining cardiovascular fitness. When returning to running, use maximally cushioned footwear, sesamoid padding in the shoe, and a gradual return-to-run program starting with flat, soft surfaces at reduced mileage and intensity. If pain recurs with any running, step back and allow more healing time.
What is the difference between sesamoiditis and a sesamoid fracture?
Sesamoiditis refers to inflammation of the sesamoid bone and surrounding soft tissue without a fracture line, while a sesamoid fracture involves an actual break in the bone—either acute (from a single high-impact event like landing from a jump) or a stress fracture (from cumulative repetitive loading). The distinction matters for treatment: sesamoiditis can typically be managed with padding, orthotics, and activity modification, while sesamoid fractures generally require a period of non-weight-bearing immobilization in a boot or cast. On X-ray, a bipartite sesamoid (a normal variant with two-part anatomy) can mimic a fracture, making diagnosis challenging. MRI reliably distinguishes sesamoiditis (bone marrow edema without fracture line), stress fracture, acute fracture, and avascular necrosis—it is the most valuable imaging study when the diagnosis is unclear or conservative treatment is not progressing.
Medical References & Sources
- American Orthopaedic Foot & Ankle Society — Sesamoiditis
- PubMed Research — Sesamoid Conditions in Athletes
- PubMed Research — Sesamoid Imaging and Diagnosis
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He diagnoses and treats sesamoiditis and sesamoid fractures in athletes, dancers, and active patients using conservative and surgical approaches.
Dr. Tom’s Recommended Insoles
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
PowerStep is the brand I prescribe most — medical-grade OTC support without the custom orthotic price tag.
- PowerStep Pinnacle Insoles — The OTC orthotic I recommend most — medical-grade arch support at a fraction of custom orthotic cost. Works in most shoes.
- PowerStep Maxx Insoles — For severe arch pain or flat feet — maximum correction and support when Pinnacle isn’t enough.
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
Join 950,000+ Learning About Foot Health
Dr. Tom shares honest medical advice, supplement reviews, and treatment guides you won’t find anywhere else.
Subscribe on YouTube →Medically Reviewed by: Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists
Ball of Foot Pain Under the Big Toe?
Sesamoiditis can mimic other conditions. Our podiatrists use advanced imaging to accurately diagnose sesamoid problems and create an effective treatment plan.
Sources
- Cohen BE. “Hallux sesamoid disorders.” Foot Ankle Clin. 2009;14(1):91-104.
- Boike A et al. “Sesamoid disorders of the first metatarsophalangeal joint.” Clin Podiatr Med Surg. 2011;28(2):269-285.
- Richardson EG. “Hallucal sesamoid pain: causes and surgical treatment.” J Am Acad Orthop Surg. 1999;7(4):270-278.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your Appointment
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Related reading: Plantar Fasciitis Secrets — our complete heel pain guide: what works and what to avoid.
Recommended Products from Dr. Tom