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Next Step Foot & Ankle Clinic

Sesamoiditis: Aching Ball of the Foot Pain

Imagine you have a pebble in your shoe, right under the ball of your foot. It’s small, so at first when you walk, it may not bother you much. After a while, though, constantly stepping on a little rock becomes increasingly painful. No one wants to keep walking when it hurts to do so.

When the problem is just a pebble, you can shake out your shoes and continue on. When the ball of the foot pain comes from sesamoiditis, though, you need to invest in your foot care to find relief.

Understanding the Sesamoid Bones

Sesamoiditis is an overuse injury to the sesamoid bones situated under the ball of your foot at the base of your big toe. These two bones are different from all the other bones in your feet. They are roughly the size of a corn kernel and embedded in tendons that attach your big toe to your first metatarsal. They serve two main purposes: increasing power and absorbing shocks. The sesamoids act like pulleys, giving your big toe more power when you push off the ground. They also provide an extra surface for weight-bearing pressure, protecting the ball of the foot.

Because they are so important for normal walking, it’s fairly easy for them to become irritated. Excessive, repetitive pressure on the forefoot strains the tendon surrounding the little bones and inflames it. This happens slowly over time, creating a gradually worsening discomfort that often increases after activities and may improve with rest. Since the problem is an overuse injury, it does not improve on its own. You need intentional intervention.

Putting on the Pressure

You can develop sesamoiditis multiple ways. Poor conditioning, particularly connected to sports, is one of the most common culprits. Sharply increasing the intensity of your activities, or beginning new ones that your lower limbs are not prepared for, can strain tendons and cause ball of the foot pain. Repetitive jumping and foot strikes can also aggravate the tissues, as well as wearing unsupportive shoes that direct pressure onto the big toe.

Typically the discomfort is a slow burning or ache. There usually isn’t any noticeable swelling or bruising. The worse the condition becomes, the more painful it may be to use the big toe. If the discomfort comes on suddenly, you may have actually fractured one of the little bones instead of just aggravated it. No matter how the problem developed, though, you’ll need to have your foot examined and correctly diagnosed so you can recover.

Healing the Ball of the Foot

Dr. Darren Silvester and our staff here at Next Step Foot & Ankle Clinic will carefully evaluate your lower limbs to rule out other possible causes for ball of the foot pain. We may request X-rays or other diagnostic images to check for fractures and other potential problems. When we have identified sesamoiditis, we can help you treat it appropriately.

Nearly all treatment for this condition is conservative. You’ll need to relieve the pressure on your forefoot to reduce the pain. This may mean changing your footwear and using pads in the insoles to help protect the sesamoids. Supportive footwear with a low heel, stiff sole, and sufficient arch stabilization helps minimize weight directed at the big toe. Orthotics can add extra cushioning, as well as correct biomechanical problems that may make the problem worse.

You’ll still need to take a break from the activities that cause discomfort, so they don’t continue to irritate your sesamoids. Icing the ball of the foot when it hurts may help lower the inflammation. If your discomfort is stubborn, we may recommend anti-inflammatory medications, or even direct injections. As the condition heals, most likely you’ll need physical therapy to help restore range of motion and strength to the big toe without reinjuring it.

Sesamoiditis is an uncomfortable problem that can make your regular activities, including walking, unpleasant. Don’t wait until you’re limping to seek help for your ball of the foot pain. Instead, let Dr. Darren Silvester and our staff at Next Step Foot & Ankle Clinic know—see how we can help you. Call (830) 569-3338 or send us an online request to make an appointment at our Pleasanton, TX, office.