Pain under the big toe can quietly interfere with walking, exercise, and daily movement. One often-overlooked cause is irritation or injury to the sesamoid bones, small structures that play an important role in how the foot functions.
Sesamoid bones are small, round bones embedded within the tendons beneath the base of the big toe. Rather than forming a traditional joint, they sit within the tendon and act like pulleys, helping absorb pressure and guide smooth movement during walking, running, and push-off.
Because these bones bear significant force with every step, they are vulnerable to overuse and stress. Sesamoid injuries are most common in active adults, runners, dancers, and individuals who spend long hours on their feet. Certain foot types, such as high arches or limited big toe motion, can further increase stress in this area. Since pain often starts in a small, localized spot, it may be dismissed early, allowing symptoms to worsen over time.
At Foot & Ankle Centers, patients with big toe and forefoot pain are evaluated by lisenced podiatrists Dr. Tavakoli, Dr. Knapp, and Dr. Treleven, serving Frisco, Little Elm, and McKinney, Texas.
What Causes Sesamoid Pain?
Sesamoid pain typically develops from repetitive stress, overuse, or direct injury. Activities that require frequent push-off from the big toe place ongoing strain on the tendons and bones in the forefoot, which can lead to inflammation or fractures.
Common causes of sesamoid pain include:
- Repetitive impact from running, jumping, or dancing
- Wearing thin-soled shoes or high heels that increase forefoot pressure
- Sudden increases in activity level
- Foot structure that concentrates pressure beneath the big toe
- Trauma, such as awkward landings or stubbing the toe
Inflammation of the sesamoid bones without a fracture is known as sesamoiditis. In other cases, a stress fracture or acute fracture may develop. Because these conditions share similar symptoms, professional evaluation is essential for accurate diagnosis.
What Are the Symptoms of a Sesamoid Injury?
Sesamoid injuries most often cause pain directly beneath the big toe joint. Symptoms may develop gradually or appear suddenly after activity. Many patients describe a deep, aching pain that worsens with walking or standing.
Symptoms may include:
- Pain under the ball of the foot near the big toe
- Swelling or bruising
- Difficulty bending or straightening the big toe
- Pain that increases with activity and improves with rest
- Stiffness or weakness during push-off
To avoid discomfort, many people unintentionally change how they walk, which can place added stress on the ankle, knee, hip, or lower back over time.
As Dr. Knapp notes, “Pain under the big toe is easy to dismiss at first, but sesamoid injuries often get worse when pressure and inflammation go untreated. Early evaluation can make recovery much easier.”
How Is Sesamoid Pain Diagnosed?
Diagnosis begins with a comprehensive foot exam. At Foot & Ankle Centers, patients are evaluated by licensed podiatrists.
During the evaluation, foot structure, range of motion, gait, and areas of tenderness are carefully assessed. X-rays are commonly used to identify fractures or alignment issues, and advanced imaging may be recommended to evaluate subtle bone stress or soft tissue involvement. Accurate diagnosis allows treatment to target the root cause of pain rather than just relieving symptoms.
Sesamoid Pain Treatment
Treatment for sesamoid injuries focuses on reducing pressure, controlling inflammation, and allowing the bone and surrounding tissues to heal. When addressed early, many cases respond well to conservative care.
Treatment options may include:
- Activity modification to reduce stress on the forefoot
- Supportive footwear with proper cushioning
- Custom orthotics to offload pressure from the sesamoid bones
- Anti-inflammatory therapies to manage pain and swelling
- Immobilization in cases of fracture or severe inflammation
Treatment plans are individualized based on activity level, foot mechanics, and symptom severity, with the goal of restoring function and preventing recurrence.
When Should You Seek Professional Care for Big Toe Pain?
Ongoing pain beneath the big toe should not be ignored. If discomfort persists despite rest, footwear changes, or home care, it may indicate an underlying sesamoid condition that requires medical attention. Early evaluation can help prevent chronic pain and long-term mobility issues.
Expert Care for Sesamoid Pain in Frisco, Little Elm, and McKinney
Although small, the sesamoid bones play a critical role in balance, comfort, and movement. With proper evaluation and personalized care, most patients are able to return to normal activities without ongoing pain.
If you are experiencing pain under your big toe, schedule an evaluation with Foot & Ankle Centers to receive expert care from Dr. Tavakoli, Dr. Knapp, or Dr. Treleven at our Frisco, Little Elm, or McKinney locations, serving patients throughout the DFW area.
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