Quick answer: Sesamoiditis Sesamoid Fracture Big Toe Michigan is a common foot/ankle topic that affects many patients. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
The most important clinical decision with Sesamoiditis Sesamoid Fracture Big Toe Michigan isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Quick Answer
Sesamoiditis & Sesamoid Fracture: Causes, Treatment � relates to foot/ankle injury — typically caused by trauma or twist. Most patients improve in 4-8 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Sesamoiditis is inflammation of one or both sesamoid bones located beneath the big toe joint — a painful condition that is frequently misdiagnosed as plantar fasciitis, metatarsalgia, or a simple bruise. Sesamoid fracture, a stress fracture through these small bones, is equally misidentified and can result in chronic non-union if not treated appropriately from the start. Dr. Tom Biernacki, DPM at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan diagnoses and treats both sesamoiditis and sesamoid fractures, including cases that have been mismanaged elsewhere and present as chronic big toe pain.
What Are the Sesamoid Bones?
The sesamoids are two small bones — the medial (tibial) sesamoid and the lateral (fibular) sesamoid — embedded within the flexor hallucis brevis tendon beneath the first metatarsal head. They function as pulleys to increase the mechanical advantage of the big toe flexor tendons, absorb weight-bearing forces during push-off, and protect the plantar surface of the first metatarsal head. Because they bear the full brunt of push-off force with every step, they are subjected to significant repetitive stress — particularly in dancers, runners, and people who wear high heels.
Approximately 10–33% of the population has a bipartite sesamoid — a sesamoid that developed from two ossification centers and never fused, appearing as a “fractured” bone on X-ray when it is actually a normal anatomical variant. Distinguishing bipartite sesamoid from acute fracture is one of the key diagnostic challenges in sesamoid evaluation, requiring assessment of the fracture line margins, comparison with the contralateral foot, and often MRI or bone scan for definitive differentiation.
Causes: Sesamoiditis vs. Sesamoid Fracture
Sesamoiditis is typically an overuse injury — repetitive microtrauma from activities that load the forefoot repeatedly: running, dancing (particularly ballet), high-heel wearing, and sports with explosive push-off demands (basketball, tennis, sprinting). The onset is gradual, with aching beneath the big toe that worsens with activity and improves with rest. The medial (tibial) sesamoid is involved approximately 75–85% of the time.
Acute sesamoid fracture results from a single traumatic event — a fall onto the ball of the foot, a sudden hyper-plantarflexion or hyper-dorsiflexion force, or a direct blow. The onset is immediate and severe, with point tenderness directly under the first metatarsal head. Stress sesamoid fractures develop gradually from cumulative loading — similar in mechanism to tibial or metatarsal stress fractures — and may not be visible on standard X-ray for 2–4 weeks after symptom onset.
Diagnosis: Clinical Examination and Imaging
The key clinical finding is point tenderness directly under the first metatarsal head, reproducible on palpation of the specific sesamoid. Passive dorsiflexion of the big toe — which stretches the flexor hallucis brevis and loads the sesamoids — typically reproduces the pain. Swelling and bruising may be present acutely. Chronic sesamoiditis may present with a palpable callus under the sesamoid area and pain that has been present for months.
Standard weight-bearing foot X-rays are obtained first; a sesamoid axial view provides the most direct visualization of both sesamoids. If X-ray is inconclusive and clinical suspicion remains high, MRI is the gold standard — it detects bone marrow edema (sesamoiditis), fracture lines, avascular necrosis, and cartilage damage with high sensitivity. We perform same-day digital X-ray at both our Howell and Bloomfield Hills offices, with MRI ordering same-day when indicated.
Treatment: Conservative Approach First
Initial treatment for both sesamoiditis and stress sesamoid fractures involves offloading the sesamoids to allow inflammation and bone healing. A dancer’s pad — a felt or foam pad with a cutout directly under the affected sesamoid — redistributes pressure away from the painful bone while allowing normal forefoot function. A rigid-soled shoe or a carbon fiber plate insert prevents the flexion moment at the first MTP that loads the sesamoids. Activity modification to eliminate the provocative movement (push-off, dancing, running) is essential.
For acute fractures or severe sesamoiditis, a short walking boot may be required for 4–6 weeks to provide more complete offloading. Non-steroidal anti-inflammatory medications help manage pain and swelling. Cortisone injection into the sesamoid region is used selectively — it can provide significant short-term relief but carries a theoretical risk of accelerating avascular necrosis if used repeatedly. MLS laser therapy has been beneficial for accelerating sesamoid healing in our clinical experience in both Howell and Bloomfield Hills.
Sesamoid fractures treated conservatively require 6–12 weeks of protected weight-bearing for union. Stress fractures with bone marrow edema on MRI but no visible fracture line have the best prognosis. Established fractures with sclerotic margins take longer and have higher non-union rates.
Surgical Treatment for Sesamoid Problems
Surgical sesamoidectomy — removal of the affected sesamoid — is reserved for cases of chronic non-union, avascular necrosis, or sesamoiditis that has failed 6+ months of conservative treatment. The medial sesamoid can be removed with preservation of the lateral sesamoid, maintaining most of the FHB mechanical function. Removal of both sesamoids is avoided — this leads to hallux extension contracture and cock-up toe deformity. Recovery after sesamoidectomy is 6–8 weeks in a walking boot followed by gradual return to activities over 3–4 months.
The Most Common Mistake with Sesamoiditis
The most common mistake: walking on the inner foot edge to avoid sesamoid pressure. This compensatory gait pattern relieves sesamoid pain in the short term but creates overloading of the tibialis anterior, spring ligament, and medial ankle — leading to a secondary injury while the sesamoid heals. The correct approach: dancer’s pad with a cutout directly under the sesamoid plus a stiff-soled shoe. This allows normal foot plant without sesamoid overload.
Warning Signs — See a Podiatrist Promptly
Seek prompt evaluation for: sudden severe pain under the big toe after a fall or jump (acute fracture requiring imaging); pain that has been present more than 4 weeks without improvement; any swelling with warmth and redness (rule out sesamoid osteomyelitis — rare but serious); toe deformity or inability to flex the big toe (FHB rupture); or diabetic patient with any forefoot pain (neuropathy masks severity).
Book a Sesamoid Evaluation — Howell & Bloomfield Hills
Dr. Tom Biernacki, DPM performs same-day X-ray, diagnostic ultrasound, and sesamoid axial views at both Balance Foot & Ankle locations. MRI is ordered same-day when clinically indicated. Call (810) 206-1402 or request an appointment online. Serving Howell, Brighton, Bloomfield Hills, Troy, and all of southeastern Michigan.
Related: Turf Toe · Second Toe Capsulitis · Metatarsal Fracture
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Treated by Dr. Tom Biernacki DPM — Board-certified podiatric surgeon at Balance Foot & Ankle in Howell & Bloomfield Hills, MI.
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Book Your AppointmentMore Podiatrist-Recommended Foot Health Essentials
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Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
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 Hills 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 Hills
Differential Diagnosis: What Else Could It Be?
Not every case of sesamoiditis is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.
| Condition | How It Differs |
|---|---|
| Sesamoid stress fracture | Acute or gradually worsening sharp pain, tender directly over one sesamoid, positive findings on MRI. |
| Hallux rigidus | Stiff, painful big toe joint with limited dorsiflexion — pain is AT the joint, not UNDER the ball. |
| Turf toe (plantar plate injury) | Acute hyperextension mechanism, diffuse swelling of the 1st MTP, positive 1st MTP drawer test. |
Red Flags — When to See a Podiatrist Now
Seek same-day evaluation at Balance Foot & Ankle if you notice any of the following:
- Sudden sharp onset (possible fracture)
- Bruising or swelling under the big toe
- Pain at rest or at night
- Inability to push off during gait
Call (810) 206-1402 or request an appointment. Our Howell and Bloomfield Hills offices reserve same-day slots for urgent foot and ankle issues.
In Our Clinic: What We See
Clinical perspective from Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Hills, MI:
In our Balance Foot & Ankle clinic, sesamoiditis patients are usually dancers, runners, or women who have spent significant time in heels. They describe pain directly UNDER the big toe joint — not at the joint (that’s hallux rigidus) — which worsens with push-off. On exam we palpate each sesamoid separately (tibial and fibular) and assess for sensitivity. We always get X-rays to look for sesamoid fracture or bipartite sesamoid (a normal variant). Treatment uses a dancer’s pad to offload the sesamoid, stiff-soled footwear to reduce push-off stress, and activity modification.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Hoy’s Complete Pain Relief Line — Dr. Tom’s Picks (2026)
Dr. Hoy’s Natural Pain Relief is Dr. Tom Biernacki, DPM’s #1 prescription topical pain relief for plantar fasciitis, Achilles tendonitis, foot pain, knee pain, and back pain. Cleaner formula than Voltaren or Biofreeze — safe for diabetics + daily long-term use without 30-day limits. Below is the complete Dr. Hoy’s product line, organized by use case.
Dr. Hoy’s Natural Pain Relief Gel (4oz Tube)Dr. Tom’s #1 Brand
The flagship Dr. Hoy’s — menthol-based natural pain relief gel. The bottle Dr. Tom hands every plantar fasciitis patient on visit one. Cleaner formula than Voltaren or Biofreeze.
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Dr. Hoy’s Natural Pain Relief Gel (8oz Pump Bottle)Dr. Tom’s #1 Brand
8oz pump bottle — same formula as the 4oz tube but 2x the value. Best for athletes, families, or chronic pain patients who use it daily.
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Dr. Hoy’s Arnica Boost Pain ReliefDr. Tom’s #1 Brand
Dr. Hoy’s + arnica boost — for bruising, swelling, post-injury inflammation. Adds arnica’s anti-inflammatory power to the standard menthol formula.
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Same Dr. Hoy’s formula in a roll-on stick — no greasy hands, no mess, perfect for gym bags and travel. TSA-friendly.
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Dr. Hoy’s Pain Relief Gel — 3-Pack BundleDr. Tom’s #1 Brand
3-pack of Dr. Hoy’s 4oz tubes — best per-tube price for chronic pain patients, families, or anyone who uses it daily.
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Top 10 Premade Orthotics — Dr. Tom’s Picks (2026)
Dr. Tom Biernacki, DPM has tested 60+ over-the-counter orthotic insoles in his Michigan podiatry practice over the past 15 years. Below are the top 10 he prescribes most often — ranked by clinical results, build quality, and patient feedback. PowerStep + CURREX brands are Dr. Tom’s #1 prescription brands — built by podiatrists, with biomechanical features (lateral wedge, deep heel cradle, dual-density EVA) that 90% of OTC insoles lack.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
The most prescribed OTC orthotic in podiatry. Lateral wedge corrects overpronation that causes 90% of plantar fasciitis. Deep heel cradle stabilizes the ankle.
- Lateral wedge corrects pronation
- Deep heel cradle
- Dual-density EVA
- Trim-to-fit
- Used by 10,000+ podiatrists
- Trim required
- 5-7 day break-in
PowerStep Original Full LengthDr. Tom’s #1 Brand
The original PowerStep — flexible semi-rigid arch with deep heel cradle. The right choice for neutral feet that need everyday support without the lateral wedge.
- Flexible semi-rigid arch
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- APMA-accepted
- Less aggressive than Pinnacle
- No lateral wedge for overpronation
PowerStep Pulse MaxxDr. Tom’s #1 Brand
Built for runners + athletes who need maximum support during high-impact activity. Engineered for forefoot strike + lateral motion.
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- Best for athletes only
CURREX RunProDr. Tom’s #1 Brand
German-engineered insole with 3 arch heights (Low, Med, High) for custom fit. Carbon-reinforced heel + dynamic forefoot.
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CURREX EdgeProDr. Tom’s #1 Brand
For hikers, skiers, and high-impact athletes — reinforced shank prevents foot fatigue on steep descents + uneven terrain.
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CURREX SupportSTPDr. Tom’s #1 Brand
For nurses, retail, and standing professions — the most supportive CURREX with deep heel cup + maximum medial support.
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Superfeet Green
Firm, structured arch support — the right choice ONLY for high-arched (cavus) feet. Wrong choice for flat feet.
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- Firm — not for flat feet
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Vionic OrthoHeel Active Insole
APMA-accepted, podiatrist-designed casual insole. Best for adding mild arch support to dress shoes + walking shoes.
- APMA-accepted
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- Less support than PowerStep
- No lateral wedge
Sof Sole Athlete
Budget athletic insole with neutral arch + gel forefoot. Decent value if you need a quick replacement.
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- Gel forefoot
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- Wears out in 6 months
- No structured arch
Spenco Polysorb Total Support
Mid-range insole with 5-zone polysorb cushioning. Decent support for standing professions.
- 5-zone cushioning
- Trim-to-fit
- Mid-price point
- Less stable than PowerStep
- No lateral wedge
Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)
If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.
Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Dr. Tom’s most-prescribed OTC orthotic. Lateral wedge corrects overpronation that causes 90% of foot pain. Deep heel cradle stabilizes the ankle. Built by podiatrists, used by patients worldwide.
- Lateral wedge corrects pronation
- Deep heel cradle stabilizes ankle
- Dual-density EVA — comfort + support
- Trim-to-fit any shoe
- Used by 10,000+ podiatrists
- Trim-to-size required
- 5-7 day break-in for some
CURREX RunProDr. Tom’s #1 Brand
3 arch heights for custom fit (Low/Med/High). Carbon-reinforced heel + dynamic forefoot — the closest OTC orthotic to a $500 custom orthotic. Engineered in Germany.
- 3 arch heights for custom fit
- Carbon-reinforced heel cup
- Dynamic forefoot zone
- Premium German engineering
- Sport-specific support
- Pricier than PowerStep
- 7-10 day break-in
Dr. Hoy’s Natural Pain Relief GelDr. Tom’s #1 Brand
Menthol-based natural pain relief — Dr. Tom’s #1 brand for fast relief without greasy residue. Safe for diabetics + daily use. Cleaner formula than Voltaren or Biofreeze.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief — 5-10 minutes
- Cleaner ingredient list than Biofreeze
- Pricier than Biofreeze
- Strong menthol scent at first
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your stress fracture, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
Doctor Hoy’s Natural Pain Relief Gel
Natural topical pain relief I use in our clinic. Arnica + camphor formula — apply directly to the area 3–4x daily. ($20–25)
Shop Doctor Hoy’s →Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Our podiatrists treat the underlying cause, not just the symptom. Same-week appointments at our Howell and Bloomfield Hills, Michigan offices.
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Or call: (810) 206-1402
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.