Sesamoiditis

"I have pain underneath my big toe, particularly while walking without shoes."

Sesamoid bones are unique in that they are not connected to any other bones in the body. There are two very small bones (about the size of a kernel of corn) on the underside of the forefoot near the big toe. These two sesamoids provide a smooth surface over which tendons controlling the big toe are located.

Causes

The sesamoids provide a support surface while the dancer is on demi-pointe. The tendon that runs between the sesamoids can become inflamed, causing sesamoiditis, a form of tendinitis. Pain is focused under the big toe on the ball of the foot. With sesamoiditis, pain may develop gradually. There may be pain while bending and straightening the big toe.

Treatment

The dancer may be required to rest and take time off from rehearsals while the pain and inflammation from sesamoiditis decreases. An assessment with our podiatrist is indicated to rule out a sesamoid fracture and to identify and correct  any underlying biomechanical issues andmuscle imbalances and assist with acute symptom relief. The use of a J-shaped pad around the area of the sesamoid to relieve pressure may be helpful, as is taping the toe so that it remains slightly downward (plantarflexed). It may take several months for the pain associated with sesamoiditis to be completely relieved. Surgical intervention to remove the sesamoid bones should only be considered after all conservative measures have been exhausted.