Sesamoid pain has a clear treatment ladder — from taping to surgery only when needed.
You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what sesamoiditis treatment in Michigan means and what works. Call (810) 206-1402 to book at Howell or Bloomfield Township.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Sesamoiditis Treatment in Michigan Ball of Foot Pain Under relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Appointments in Howell + Bloomfield Township: (810) 206-1402.
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, Howell & Bloomfield Township, MI. Last updated April 2026.
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See Dr. Tom’s Top Shoe Picks →Sesamoiditis is inflammation of one or both sesamoid bones — two small, pea-sized bones embedded within the flexor hallucis brevis tendon beneath the first metatarsophalangeal joint (the ball of the foot at the base of the big toe). These bones function as a pulley for the flexor tendon and take significant mechanical load during push-off with every step. Sesamoiditis causes aching or sharp pain directly under the big toe joint that worsens with walking, running, wearing heels, or pushing off during athletic activity. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki evaluates and treats sesamoiditis conservatively in most cases, with surgery reserved for rare refractory cases.
Causes and Who Gets It
Sesamoiditis develops from repetitive overload of the sesamoid bones and surrounding soft tissues. High-risk groups include dancers (particularly ballet dancers, due to extreme plantarflexion loading), runners (especially those with a forefoot striking pattern or high arches), athletes in sports requiring explosive push-off (basketball, sprinting), and individuals who have recently increased training intensity or changed to less cushioned footwear. Structural factors that increase sesamoid loading include cavus (high arch) foot, plantarflexed first ray (the big toe mechanism sitting lower than the rest of the foot), and hallux valgus (bunion). Sesamoiditis can progress to sesamoid stress fracture (bipartite sesamoid must be distinguished from acute fracture by MRI or bone scan).
Treatment
Conservative treatment is effective in the vast majority of sesamoiditis cases. Relative rest and activity modification (reducing or eliminating the offending activity) is the first step. Sesamoid padding — a J-shaped pad that offloads the sesamoid area while maintaining support for the surrounding metatarsal heads — provides immediate relief. Custom orthotics with a first-ray cutout or sesamoid accommodative relief distribute weight away from the inflamed sesamoids during all weight-bearing activity. Low-heeled, well-cushioned footwear (avoiding heels and minimalist shoes) reduces sesamoid load during gait. Corticosteroid injection into the first MTP joint or directly adjacent to the sesamoids provides significant anti-inflammatory benefit for moderate-severe cases. In cases of sesamoid stress fracture or osteonecrosis (avascular necrosis of the sesamoid), a period of non-weight-bearing casting may be required. Surgical sesamoidectomy (removal of the affected sesamoid) is reserved for cases that fail all conservative measures over 6+ months and is highly effective for appropriately selected patients.
More Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
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 online booking 24/7 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 long does sesamoiditis take to heal?
Mild sesamoiditis with activity modification and appropriate offloading typically improves significantly in 6–12 weeks. Moderate cases with sesamoid stress reaction may require 3–4 months of modified activity. True sesamoid fractures may require 4–6 months of offloading. Sesamoiditis tends to recur if the underlying biomechanical cause (high arch, plantarflexed first ray) is not addressed with orthotics — so ongoing orthotic use is typically recommended even after symptoms resolve.
How do I know if I have sesamoiditis or a sesamoid fracture?
Sesamoiditis and sesamoid fracture present similarly with pain under the big toe joint. X-rays can show a sesamoid fracture, but many people have a bipartite sesamoid (a naturally split sesamoid that mimics a fracture). MRI or a bone scan distinguishes acute fracture (with bone marrow edema) from bipartite sesamoid (which has smooth, corticated edges) and from sesamoiditis (which shows soft tissue inflammation without bony injury). An accurate diagnosis guides the appropriate treatment intensity and timeline.
Can I run with sesamoiditis?
Running with active sesamoiditis typically worsens and prolongs the condition by continuing to load the inflamed tissue. Most podiatrists recommend reducing or eliminating running during the acute phase. Pool running, cycling, and swimming maintain cardiovascular fitness without sesamoid loading. Return to running should be gradual (starting with walking, then walk-run intervals) after symptoms resolve and should always be done in well-cushioned shoes with a sesamoid-offloading orthotic.
Ball of foot pain under the big toe is treatable — don’t let it become a chronic problem. Contact Balance Foot & Ankle to schedule an evaluation with Dr. Biernacki in Southeast Michigan.
Dr. Tom’s Recommended Insoles
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Book online 24/7 at either office.
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.
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we trust for our own patients.
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Howell Office
4330 E Grand River Ave
Howell, MI 48843
Get Directions →
Bloomfield Township Office
43494 Woodward Ave, #208
Bloomfield Township, MI 48302
Get Directions →
Most 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 — 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 to book an appointment.
