Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
| Treatment Option | Best Candidate | Recovery Time | Success Rate | Notes |
|---|---|---|---|---|
| Offloading Pad / J-Pad | Mild-moderate sesamoiditis | 4–8 weeks | 70–80% | First-line treatment; offloads ball of foot |
| Custom Orthotics | Recurrent / biomechanical cause | Ongoing | 75–85% | Metatarsal pad built into orthotic shell |
| Corticosteroid Injection | Acute inflammation, failed conservative care | 2–4 weeks pain relief | 60–70% | Max 2–3 injections; risk of sesamoid avascular necrosis |
| Cam Boot / Immobilization | Sesamoid stress fracture, severe cases | 6–8 weeks | 80–90% | Required for fracture healing |
| Sesamoidectomy Surgery | Failed 6+ months conservative, AVN | 6–12 weeks | 85–90% | Preserves flexor hallucis brevis tendon |
| Condition | Key Differentiator | X-Ray Finding | MRI Finding | Treatment Difference |
|---|---|---|---|---|
| Sesamoiditis | Gradual onset, ball of foot | Normal or bipartite | Bone edema, intact | Conservative first |
| Sesamoid Stress Fracture | Athletes, sudden increase in load | Cortical break | Fracture line, edema | Immobilization required |
| Bipartite Sesamoid | Often bilateral, smooth edges | Two smooth pieces | No edema (normal variant) | Treat only if symptomatic |
| Avascular Necrosis | History of injections or fracture | Sclerosis, fragmentation | Loss of signal, collapse | Often requires sesamoidectomy |
| Gout / Pseudogout | Episodic, uric acid history | Soft tissue swelling | Crystal deposits | Anti-inflammatory, urate lowering |
Quick answer: Treatment for sesamoiditis treatment michigan podiatrist follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
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Watch: BEST Sesamoiditis Treatment [Sesamoid Bone Pain & Fracture FIX] — MichiganFootDoctors YouTube
What Are the Sesamoid Bones?
The sesamoid bones are two pea-sized bones embedded within the flexor hallucis brevis (FHB) tendon on the plantar surface of the first metatarsophalangeal (MTP) joint—the big toe joint. They function like pulleys, increasing the mechanical advantage of the FHB tendon, absorbing weight-bearing forces at push-off, and protecting the flexor hallucis longus (FHL) tendon as it passes beneath the first metatarsal head. The medial (tibial) sesamoid bears more load and is injured more frequently than the lateral (fibular) sesamoid.
Causes of Sesamoiditis
Sesamoiditis is an overuse condition resulting from repetitive, concentrated pressure and microtrauma at the first MTP joint. Activities that increase load at the ball of the foot—dancing (especially ballet en pointe), running, jumping, basketball, tennis, and high-heel wear—are the most common culprits. High-arched (cavus) feet place extra load on the metatarsal heads, increasing sesamoid stress. Low-arched (planus) feet can produce abnormal sesamoid mechanics through hyperpronation. Direct trauma from a single event (landing hard from a jump) can cause acute sesamoid injury, and stress fractures of the sesamoid may be confused with sesamoiditis.
Symptoms and Diagnosis
The cardinal symptom is pain and tenderness directly beneath the big toe joint, localized to the ball of the foot. Pain is typically sharp with push-off during walking or running, and may be accompanied by swelling, bruising, or limited big toe dorsiflexion. Wearing high heels or shoes with thin soles aggravates symptoms. Runners report worsening pain during the late-stance push-off phase of the gait cycle.
Dr. Biernacki evaluates sesamoiditis with weight-bearing X-rays to identify sesamoid position, bipartite sesamoid (a normal variant that can mimic fracture), osteonecrosis (avascular necrosis), or arthritic changes. MRI is used when sesamoid stress fracture or avascular necrosis is suspected—both diagnoses that significantly alter treatment. Bone scan can confirm stress fracture activity. In-office diagnostic ultrasound assesses bursitis or tendinopathy of the FHB tendon.
Conservative Treatment
Most sesamoiditis cases respond well to conservative management. Offloading is the cornerstone of treatment—custom orthotics with a sesamoid relief cutout redistribute pressure away from the first metatarsal head. J-shaped or dancer’s pads (adhesive felt padding) provide immediate relief and can be applied directly to the foot or insole. A stiff-soled shoe or carbon fiber plate insole limits big toe extension and reduces sesamoid stress during push-off.
Activity modification reduces cumulative loading, and a walking boot may be needed for acute or severe presentations. Corticosteroid injection into the first MTP joint or sesamoid bursa provides powerful anti-inflammatory relief. Physical therapy addresses FHB and FHL flexibility and strength, and helps correct gait mechanics contributing to overload. Sesamoid stress fractures are treated with strict non–weight-bearing for 6–8 weeks followed by gradual progressive loading.
Surgical Treatment: Sesamoidectomy
When 3–6 months of thorough conservative treatment fails to provide adequate relief, sesamoidectomy—surgical removal of one or both sesamoids—is considered. The medial (tibial) sesamoid is the more commonly removed bone. Dr. Biernacki performs sesamoidectomy through a small plantar or dorsal-medial incision, carefully preserving the FHB tendon to prevent hallux valgus (bunion) deformity or hallux extensus (cock-up toe). Recovery involves protective weight-bearing in a post-operative shoe for 4–6 weeks, followed by gradual return to activity over 3–6 months. Outcomes are generally favorable in appropriately selected patients.
Osteonecrosis and Bipartite Sesamoid
Avascular necrosis (osteonecrosis) of the sesamoid results from disruption of blood supply, often following a stress fracture or repeated corticosteroid injections. MRI shows low signal intensity within the sesamoid. Osteonecrosis does not always require surgery—some cases heal with prolonged non–weight-bearing and orthotic protection. Fragmentation and persistent pain are indications for sesamoidectomy. Bipartite sesamoid (a normal anatomical variant in 10–30% of people) must be distinguished from acute fracture—the margins are smooth and rounded in bipartite sesamoid versus sharp and irregular in fracture.
Why Choose Dr. Tom Biernacki?
Sesamoiditis is frequently misdiagnosed as a generic “ball-of-foot pain,” leading to ineffective treatment and prolonged disability. Dr. Biernacki uses advanced imaging to distinguish sesamoiditis from sesamoid stress fracture, bipartite sesamoid, osteonecrosis, and FHB tendinopathy—diagnoses that require different management. When surgery is needed, his meticulous sesamoidectomy technique preserves the FHB tendon and minimizes the risk of post-operative deformity. Balance Foot & Ankle provides custom orthotics fabricated in-office for long-term sesamoid offloading and pressure redistribution.
Dr. Tom's Product Recommendations
Silipos Metatarsal Cushion Pads
⭐ Highly Rated
Gel metatarsal pads that offload the ball of the foot and provide cushioning relief for sesamoiditis and ball-of-foot pain.
Dr. Tom says: “These pads gave me immediate relief from the sharp pain under my big toe. Used them in all my shoes.”
Mild-to-moderate sesamoiditis, ball-of-foot pain, dancer’s neuroma
Will not address severe sesamoiditis or sesamoid fracture without additional offloading measures
Disclosure: We earn a commission at no extra cost to you.
New Balance 1080 Running Shoe
⭐ Highly Rated
High-cushion running shoe with a roomy toebox that reduces forefoot impact forces and accommodates orthotic insoles for sesamoiditis management.
Dr. Tom says: “Switched to these after my sesamoiditis diagnosis and the difference was night and day. Much less pain on my runs.”
Runners and walkers managing sesamoiditis needing maximum cushion and reduced forefoot pressure
High-heeled dress shoes or thin-soled shoes are contraindicated with active sesamoiditis
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Most sesamoiditis cases resolve with conservative treatment—custom orthotics, padding, and activity modification
- Corticosteroid injection provides rapid anti-inflammatory relief for acute flare-ups
- Sesamoidectomy is highly effective for refractory cases with good long-term outcomes when tendon is preserved
❌ Cons / Risks
- Sesamoid injuries heal slowly due to limited blood supply—expect 2–4 months of conservative treatment minimum
- Sesamoid stress fractures require strict non–weight-bearing and extended recovery
- Sesamoidectomy carries a risk of post-operative hallux valgus or hallux extensus if FHB tendon is not carefully preserved
Dr. Tom Biernacki’s Recommendation
Sesamoiditis is a diagnosis that deserves a proper workup—not just rest and anti-inflammatories. I always want to know whether we’re dealing with true sesamoiditis, a stress fracture, osteonecrosis, or a bipartite sesamoid, because the treatment is quite different for each. An X-ray alone isn’t enough if the presentation is acute or severe. Custom orthotics with a sesamoid relief pad are extremely effective, and when we do need to operate, preserving that flexor brevis tendon is non-negotiable.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
How long does sesamoiditis take to heal?
Mild sesamoiditis with good compliance responds in 4–8 weeks. More severe cases with partial stress fracture may take 3–6 months. Complete sesamoid fractures with osteonecrosis may require surgery or 6+ months of treatment.
Is sesamoiditis the same as a sesamoid fracture?
No. Sesamoiditis is inflammation without a discrete fracture line. A sesamoid fracture is an acute or stress-related break. However, chronic sesamoiditis can progress to stress fracture if overloading continues. MRI distinguishes the two diagnoses.
Can sesamoiditis go away on its own?
Mild cases may resolve with rest and shoe changes, but sesamoiditis caused by biomechanical problems typically recurs without addressing the underlying cause with orthotics or footwear modification.
What shoes are best for sesamoiditis?
Shoes with thick, cushioned soles, a stiff forefoot (to reduce push-off load), and a wide toebox. Carbon fiber insole plates and custom orthotics with a sesamoid relief cutout provide the best long-term protection.
When is sesamoidectomy (sesamoid removal) necessary?
Sesamoidectomy is considered after 3–6 months of failed conservative treatment, in cases of osteonecrosis with fragmentation, or in sesamoid fractures with non-union. Dr. Biernacki discusses surgical criteria individually with each patient.
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📞 (810) 206-1402 Book Online →Foundation Wellness Orthotic Selector — PowerStep + CURREX by Condition (2026)
Find the right Foundation Wellness orthotic for YOUR specific condition. Dr. Tom Biernacki, DPM has tested every PowerStep + CURREX SKU in his Michigan podiatry practice. Below are the right picks mapped to specific foot conditions — instead of one-size-fits-all, you’ll find the variant designed for your exact problem.
PowerStep Pinnacle MaxxDr. Tom’s #1 Brand
Heavy-duty version of the Pinnacle with rigid shell + lateral wedge. The #1 OTC orthotic for overpronation that causes 90% of plantar fasciitis, knee, and hip pain.
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PowerStep PinnacleDr. Tom’s #1 Brand
Flagship PowerStep — semi-rigid arch with deep heel cradle. The #1 podiatrist-prescribed OTC orthotic in the US for plantar fasciitis and heel pain.
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PowerStep Pinnacle High ArchDr. Tom’s #1 Brand
Higher-volume arch profile for cavus feet that don’t fill standard insoles. Prevents the lateral roll that causes ankle sprains in supinators.
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- Only for high arches
- Wrong choice for flat feet
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Pinnacle with built-in metatarsal pad — eliminates the burning ball-of-foot pain from Morton’s neuroma + metatarsalgia.
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PowerStep Morton’s Extension InsoleDr. Tom’s #1 Brand
Stiffener under the 1st MTP joint — limits big toe extension. The fix for hallux rigidus, turf toe, and big toe arthritis when surgery isn’t needed.
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PowerStep ProTech Full LengthDr. Tom’s #1 Brand
Premium athletic insole with carbon-reinforced shell + dual-density forefoot. Best PowerStep for serious athletes.
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PowerStep Slim Profile (Dress Shoes)Dr. Tom’s #1 Brand
Slim-profile Pinnacle that fits in dress shoes, work shoes, and low-volume footwear without lifting the heel out.
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- Same Pinnacle arch
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PowerStep Wide (EE / EEE Fit)Dr. Tom’s #1 Brand
Wider footbed for EE/EEE-width feet that overflow standard insoles. Same Pinnacle support, wider sole.
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CURREX RunPro (3 Arch Heights)Dr. Tom’s #1 Brand
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CURREX WalkProDr. Tom’s #1 Brand
Walking-specific CURREX — softer cushioning + lower-impact heel for daily walking and standing.
- Walking-specific cushioning
- 3 arch heights
- Premium materials
- Pricier
- Not for high-impact running
CURREX AceProDr. Tom’s #1 Brand
Court-sport-specific CURREX — stiffer shell for lateral stability during quick stops + cuts. Pickleball + tennis + basketball.
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CURREX EdgeProDr. Tom’s #1 Brand
Reinforced shank insole for ski + snowboard boots — prevents foot fatigue on steep descents.
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Hiking + backpacking insole — extra heel cushion + reinforced midfoot for uneven terrain.
- Extra heel cushion
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- Bulky in low-volume shoes
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CURREX BikeProDr. Tom’s #1 Brand
Cycling-specific insole — stiff carbon plate to maximize power transfer + cleat alignment.
- Stiff carbon plate
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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
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- 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.
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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.
- Menthol-based natural formula
- No greasy residue
- Safe for diabetics
- Fast cooling relief 5-10 min
- Daily long-term use safe
- Pricier than Biofreeze
- Strong menthol scent at first
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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- Specialty use
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Dr. Hoy’s Natural Pain Relief Roll-OnDr. Tom’s #1 Brand
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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- Need storage space
Frequently Asked Questions
What is Sesamoiditis?
Sesamoiditis is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of sesamoiditis include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of sesamoiditis respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from sesamoiditis varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.