Sesamoiditis Treatment Michigan

Sesamoiditis is inflammation of the sesamoid bones — two small bones embedded within the flexor hallucis brevis tendon beneath the first metatarsal head. It is a common cause of ball of foot pain under the big toe in dancers, runners, and athletes. Dr. Tom Biernacki DPM at Balance Foot & Ankle provides expert sesamoiditis treatment in Michigan at our Howell, Brighton, and Bloomfield Hills offices.

What Are Sesamoid Bones?

The two sesamoids (medial/tibial and lateral/fibular) act as a pulley system for the flexor hallucis brevis, enhancing the mechanical advantage of the big toe during pushoff. They also bear significant body weight through the first ray. Because of their role in propulsion, sesamoids are highly susceptible to overuse injury, fracture, and avascular necrosis — especially in high-demand activities.

Sesamoiditis Symptoms

• Gradual onset pain directly under the first metatarsophalangeal (MTP) joint
• Pain worsened by walking barefoot, going up stairs, or wearing high heels
• Tenderness with direct palpation of the sesamoid(s)
• Swelling and bruising in acute cases
• Stiffness of the big toe

Diagnosis: Sesamoiditis vs. Sesamoid Fracture

Accurate diagnosis is critical because sesamoiditis, sesamoid stress fracture, bipartite sesamoid (a normal anatomic variant), and avascular necrosis all present similarly but require different management. Dr. Biernacki obtains weight-bearing X-rays with a sesamoid axial view, and orders MRI when stress fracture or avascular necrosis is suspected. MRI differentiates acute fracture from bipartite sesamoid by identifying bone marrow edema.

Treatment Options

Offloading is the cornerstone of sesamoiditis treatment. A dancer’s pad — a J-shaped felt pad that cups the sesamoid area — is the simplest immediate measure. Custom orthotics with a first-ray cutout are prescribed for long-term pressure relief. Activity modification and low-impact substitution (cycling, swimming) allow healing while maintaining fitness.

Immobilization with a CAM boot or short leg cast is used for sesamoid stress fractures. Healing typically requires 6–8 weeks of non-weight-bearing or protected weight-bearing, followed by a gradual return to activity.

Corticosteroid injection under ultrasound guidance reduces inflammation in chronic sesamoiditis when conservative measures have failed. Dr. Biernacki uses in-office ultrasound to guide the injection precisely without radiation.

Surgical sesamoidectomy — partial or complete removal of one sesamoid — is reserved for avascular necrosis, chronic non-union fracture, or refractory pain. Careful planning is essential to preserve big toe function after removal.

Frequently Asked Questions

Book a same-week appointment at Balance Foot & Ankle in Michigan. Dr. Biernacki treats sesamoiditis at our Howell, Brighton, and Bloomfield Hills locations.