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Below the big toe, there are two unique, small bones that are not connected to another bone, the sesamoid bones. These bones sit within the flexor halluces longus tendon working to facilitate the tendons glide across the big toe and to help redistribute pressure across the large 1st bone of the metatarsals. There are very few sesamoid bones in the body, the kneecap (patella) is the largest sesamoid bone in the body.


These 2 small sesamoid bones are subjected to immense levels of stress with every step taken. There are 3 main types of injury that can occur specifically to the sesamoid bones in the ball of the foot:


  1. Inflammation (Sesamoiditis)
  2. Fracture
  3. Arthritis

Pain will be focused directly on the 1st metatarsal and big toe, if left long enough the pain will radiate into the foot with an obvious difficulty with bending and straightening the big toe. Swelling and bruising in this location should be addressed immediately.


Injuries to these bones may occur suddenly or over a long period. Patients may not even know there is an injury until they feel pain or take an x-ray. Factors that increase the likelihood of developing sesamoid problems include:


  • Participation in high intensity, heavy forefoot loading sports or recreational activities. Zumba, circuit training, dancing, football, basketball, etc.
  • Pivotal motions that caused a sudden injury to the forefoot.
  • Wearing medium to super high heels that increase loading on the ball of the foot.
  • Wearing soft shoes that allow the foot to mould into any shape it wants.
  • Wearing slippers that offer no support and increase the chance of injury to the foot.

Forefoot Pain | East Coast Podiatry

Most patients do not know they have these small bones at the front of the foot let alone an injury to them. Injury to these bones results in chronic (long standing) pain in the ball of the foot. Leaving such an injury can result in a surgical intervention of the affected bone, early intervention is key to success in treating such injuries.


Sesamoid problems must have a clear diagnosis from your foot specialist.


Treatments may include:

  • Clinical assessment
  • Radiological evaluation
  • Offloading
  • Treatment to heal the injury
  • Footwear changes or modifications


Pain in the sesamoids must be differentiated from other similar problems, patients must rule out:


  • Gout
  • Hallux limitus
  • Flexor halluces longus tendonitis (or tear)
  • Ligament injury around the 1st metatarsal joint
  • Referred pain from another location of the foot
  • 2nd metatarsal overload (Freiburg’s disease)
  • Foot hypermobility
  • Pes planus / flatfoot
  • Reactive arthritis


Learn More…