Sesamoiditis is inflammation of the sesamoid bones — two small, pea-sized bones embedded within the tendons beneath the big toe joint (the first metatarsophalangeal joint). These bones act like a pulley, helping to transmit force from the flexor tendons, absorb weight-bearing load and enable the smooth, powerful push-off phase of walking and running.

When these bones are subjected to repetitive stress or sudden overload, the surrounding tendons and tissue become inflamed and painful. Sesamoiditis is particularly common in runners, dancers, athletes and anyone who spends long periods on the balls of their feet — and it can be frustratingly slow to resolve if not managed correctly from the outset.

Accurate diagnosis is important as several conditions can cause pain in the same area — including a sesamoid stress fracture, sesamoid avascular necrosis, flexor hallucis longus tendinopathy, a bunion or first metatarsophalangeal joint arthritis. Each has a different management pathway, so getting the diagnosis right at the outset saves time and avoids ineffective treatment.

At your appointment we will take a thorough history, physically examine the foot and assess the range of motion of the big toe joint. We will also assess your gait on our treadmill using Onform joint tracking software to identify any biomechanical loading patterns contributing to the problem — such as excessive pronation, forefoot varus or altered push-off mechanics. If a stress fracture is suspected we will refer for imaging.