If you’ve recently ramped up activities such as running, dancing, or contact sports like soccer or basketball, you may notice pain around your big toe joint. And you may be surprised to learn that there’s a name for it: sesamoiditis. While it can be very uncomfortable, staying active with  sesamoiditis won’t do further harm, says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. 

Sesamoiditis usually occurs when you’ve gone past your body’s movement sweet spot and started activities or increased intensity to a degree that your body isn’t quite ready for. But you don’t have to suffer with sesamoiditis in silence. The best way to move past it is to focus on stretching and strengthening exercises for your foot and big toe, advises Dr. Kimbrough. 

Read on to learn more about what causes sesamoiditis, what it feels like, and, most importantly, which exercises and stretches can help you feel better, according to our Hinge Health physical therapists. 

What Is Sesamoiditis?

Sesamoiditis refers to inflammation or irritation of the two pea-sized sesamoid bones in your big toe, says Dr. Kimbrough. These bones are located right under your big toe joint, and your big toe flexor tendon is attached to them.

Your sesamoid bones act like pulleys and provide a smooth surface for your big toe flexor tendon to slide over. This is what allows you to push off, so that you can do explosive moves such as jumping, explains Dr. Kimbrough. Though small, the sesamoid bones also play a role in supporting your body weight.

When you have sesamoiditis, both the bones and tendons can become inflamed, says Dr. Kimbrough.

Symptoms of Sesamoiditis

Sesamoiditis symptoms often come on gradually, says Dr. Kimbrough. It may start as a dull ache, then develop into more intense pain. Signs of sesamoiditis often include:

• Pain focused right under your big toe

• Pain that worsens when you put weight on the big toe

• Pain that worsens with jumping or any sort of movement where you push off of your big toe

• Pain or difficulty bending or straightening your big toe

• Swelling

Sesamoiditis: A Hinge Health Perspective

Learning about conditions that cause foot pain can be alarming. We know from Hinge Health members and research studies that anatomical labels like these can backfire when it comes to your treatment and recovery. When people hear they may have a condition like sesamoiditis, it can cause feelings of panic, like you have something "wrong" with your foot that needs to be fixed. This way of thinking about pain is largely outdated.

Pain is more complex than simply what may or may not be happening in your big toe joint. Other factors, like life stressors, can also play a big role in how you experience pain. And for most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same. 

Movement — through physical and exercise therapy — builds strength, flexibility, and resilience to pain. “Patients may be scared to exercise, because they think it will make their pain worse, but it actually helps you recover,” stresses Dr. Kimbrough. “If you don’t move, the muscles around your sesamoid bones will stiffen up, which can make pain worse.”

Gentle movement as well as stretching and strengthening exercises can go a long way when it comes to treating sesamoiditis (more on that below). “The good news is that pain around the sesamoid bones is usually not a sign of anything serious,” reassures Dr. Kimbrough. “But since it can be uncomfortable, it’s important to strengthen that area. Movement also increases blood flow to the region, which helps to promote healing.”

Regular aerobic activity is also important. While you may not be able to tolerate usual activities such as running or jumping for a short period, it’s important to keep moving with lower intensity activities. Listen to your body, and let pain be your guide. The goal is to strengthen your foot muscles enough to take pressure off your sesamoid bones as they heal. Then, you’ll be able to fully return to all the activities you enjoy.

Causes of Sesamoiditis

Sesamoiditis is usually caused by doing more activity than your body is ready for. “Your sesamoid bones help with explosive motion,” explains Dr. Kimbrough. “So if you do a lot of repetitive moves, such as running or jumping, over time it can lead to inflammation in this area.” 

While sesamoiditis can happen to anyone, research suggests it’s particularly likely to occur among:

• Runners

• Ballet dancers

• Baseball catchers

• Basketball players

• Soccer players

These are all activities where you frequently go up on your toes or balls of your feet, points out Dr. Kimbrough. You may also be more likely to develop it if you wear high heels frequently. “Heels put a lot of weight-bearing pressure right over where your sesamoid bones are,” explains Dr. Kimbrough.

And remember: Pain during these activities doesn’t mean you have to stop doing them. It’s just a sign that your big toe joint and muscles may need to get stronger in order to support you during these movements.

Treatment Options for Sesamoiditis

Hinge Health physical therapists recommend the following sesamoiditis treatments:

Footwear changes. While there’s no perfect shoe that works well for everyone, those with sesamoiditis may do well with rocker bottom shoes, which are a type of shoe that forms a U-shape on the bottom, says Dr. Kimbrough. You can also try limiting wearing shoes with heels, since they put more pressure on the sesamoid bones, says Dr. Kimbrough. Ditto for going barefoot, which also puts more stress on your sesamoid bones.

Felt cushioning pad. These bandage-like adhesive pads can be placed right under your sesamoid bones to provide cushioning and relieve pressure. Another option, if the pain is more severe, is to tape your big toe so that it remains bent slightly downward. These two options may help you return to activity more quickly.

Physical therapy. A physical therapist (PT) can create an exercise program to help you strengthen and improve range of motion in your ankle and big toe. “Since sesamoiditis can decrease your range of motion, it can make it harder for you to push off with your big toe,” says Dr. Kimbrough. A PT can help make your toe flexors stronger, for example, to build up strength and decrease inflammation in that area. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Activity modifications. Some low-level discomfort in the big toe is fine, reassures Dr. Kimbrough. But you want to temporarily avoid or modify any exercise that causes unacceptable levels of pain or cause your pain to flare for more than a day. You might modify higher impact activities if they are too painful or substitute in some low-impact or no-impact activities like biking, rowing, or swimming to help calm your symptoms.

Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for sesamoiditis pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

Stretching and strengthening the muscles in and around the foot can help ease sesamoiditis pain, aid in recovery, and prevent future problems. The above sesamoiditis exercises, recommended by Hinge Health physical therapists, are a great place to start.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Consider Orthotics 

Orthotics, or shoe inserts, can be helpful if you experience sesamoiditis, especially if you have flat feet or high arches, says Dr. Kimbrough. “In either of these situations, an orthotic can be helpful to take pressure off the sesamoid bones,” she explains. Talk to your physical therapist about whether or not it makes sense to try an over-the-counter pair. If those don’t provide relief, you may want to see a foot specialist for custom-made orthotics.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. York, P. J., Wydra, F. B., & Hunt, K. J. (2017). Injuries to the great toe. Current Reviews in Musculoskeletal Medicine, 10(1), 104–112. doi:10.1007/s12178-017-9390-y

2. Sugimoto, D., Gearhart, M. G., Kobelski, G. P., Quinn, B. J., Geminiani, E. T., & Stracciolini, A. (2021). Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic. Clinical Journal of Sport Medicine, 32(3), pe276-e280. doi:10.1097/jsm.0000000000000902

3. Kaur, P., Carroll, M., & Stewart, S. (2023). The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand. Journal of Foot and Ankle Research, 16(1). doi:10.1186/s13047-023-00628-w

4. Beahrs, T. (2023, October). Sesamoiditis and Sesamoid Fracture. OrthoInfo - AAOS. https://orthoinfo.aaos.org/en/diseases--conditions/sesamoiditis 

5. Fields, K. B., & Atkinson, B. (2024, March 4). Evaluation, diagnosis, and select management of common causes of forefoot pain in adults. UpToDate. https://www.uptodate.com/contents/evaluation-diagnosis-and-select-management-of-common-causes-of-forefoot-pain-in-adults