Pain Under The Big Toe

If you suffer from pain under the ball of your big toe, it could be several things but one very common issue is an injury to your sesamoid bones. So what are your sesamoid bones? Well, our podiatrist Tess explains.

The sesamoid bones are round bones embedded into or close to a tendon. They are found in the knee, hand, wrist and of course the foot.  In the foot, they are small rounded bones located in the base of the big toe. These tiny bones resemble sesame seeds, hence their name. The sesamoids provide an anchor for the tendon to glide and allow for enhanced movement at the area. They are very important in optimising effective toe-off during walking and running. 

What is sesamoiditis?

Inflammation of the sesamoids of the big toe and its surrounding structures. The pain may be due to arthritis, blood flow restriction or fracture but is most commonly due to inflammation. 

What can contribute to sesamoiditis? 

  • Excessive loading or pressure under the big toe joint
  • Dancers, sprinters and footballers are at risk due to being on the ball of the foot predominantly
  • Shape or position of your big toe relative to your other toes such as a more flexed position
  • Too much exercise too soon (training overload)
  • Low bone density
  • Excessive body weight
  • Teens and young adults are more prone


  • Usually a dull achy pain with sharp pain upon weight bearing
  • Pain when pressing under the big toe joint
  • Extending the big toe


Usually, a diagnosis is made based on a physical assessment of your feet by a podiatrist. Occasionally an x-ray, ultrasound or MRI is required if the diagnosis is uncertain or there is minimal improvement with treatment, 


  • Ice and anti-inflammatories in the early-stage to settle the pain and inflammation. 
  • Ultimately reducing the pressures/loads to the big toe via footwear changes, padding, taping and potential orthotics. 
  • Strengthening the structures surrounding the area is important too. 

Patients who present for an assessment earlier tend to return to chosen sports and activities faster than those who hold off on care. One of our very competent podiatrists will thoroughly assess you and devise an individualised management plan. 


By Tess Hosken, Podiatrist at Melbourne Podiatry Clinic