Sesamoiditis (Pain Under the Big Toe)
Do you feel pain under the ball of your foot, especially beneath your big toe? Does walking, running, or wearing thin-soled shoes make the discomfort worse? You may be experiencing sesamoiditis, commonly described as pain under the big toe joint, a condition that affects the small bones beneath the front of the foot.
At Rose Physical Therapy, with clinics in Navy Yard, Friendship Heights, and Farragut North in Washington, DC, physical therapists provide personalized care to help reduce sesamoid pain, improve foot mechanics, and restore comfortable movement.
Understanding Sesamoiditis
The sesamoid bones are two small, pea-shaped bones located beneath the head of the first metatarsal bone, directly under the big toe joint. These bones are embedded within a tendon and help absorb pressure while assisting with push-off during walking and running.
Sesamoiditis occurs when these bones and the surrounding tissues become irritated from repeated stress or excessive pressure. Because the sesamoids bear significant weight during movement, inflammation in this area can make everyday activities uncomfortable.
If the irritation continues without treatment, the condition may sometimes progress to a stress injury of the sesamoid bones.
Common Causes and Risk Factors
Several factors can increase pressure on the sesamoid bones.
Repetitive Activity
Running, dancing, jumping, or activities that involve frequent push-off from the toes may overload the area.
Foot Structure
High arches or a rigid forefoot can place more pressure on the ball of the foot.
Unsupportive Footwear
Thin-soled shoes or high heels may increase stress on the sesamoid bones.
Altered Walking Mechanics
Changes in walking or running patterns may increase pressure beneath the big toe.
Sudden Increase in Activity
Rapid increases in exercise intensity or training volume may irritate the sesamoid bones.
Signs and Symptoms of Sesamoiditis
Symptoms typically occur beneath the big toe joint and may worsen with activity.
Common signs include:
• Aching or sharp pain under the ball of the foot near the big toe
• Pain that increases with walking, running, or standing on the toes
• Tenderness when pressing beneath the big toe joint
• Swelling around the front of the foot
• Difficulty bending the big toe comfortably
• Pain that worsens when barefoot or wearing thin shoes
Some individuals may also feel a bruised or sore sensation during push-off when walking.
How Sesamoiditis Is Evaluated
At Rose Physical Therapy, evaluation focuses on identifying the cause of pressure beneath the big toe and how foot mechanics contribute to symptoms.
Your physical therapist may perform:
• Review of activity levels, footwear, and symptom patterns
• Palpation of the sesamoid bones and surrounding tissues
• Assessment of big toe joint mobility
• Evaluation of foot posture and arch mechanics
• Observation of walking and push-off during gait
• Strength testing of the foot, ankle, and hip muscles
If symptoms suggest a possible stress fracture, imaging may be recommended through a medical provider.
Physical Therapy for Sesamoiditis
Treatment focuses on reducing pressure on the sesamoid bones while improving foot strength and mechanics.
At Rose Physical Therapy, rehabilitation programs are tailored to each patient’s symptoms and activity goals.
Manual Therapy
Hands-on treatment may help reduce tension in surrounding muscles and improve mobility.
Offloading Techniques
Padding or taping may help reduce pressure on the sesamoid region during healing.
Foot Strengthening
Exercises targeting the intrinsic foot muscles help support the arch and improve pressure distribution.
Ankle and Lower Leg Strengthening
Strengthening surrounding muscles helps improve push-off mechanics.
Movement and Gait Training
Therapists may adjust walking or running mechanics to reduce stress on the forefoot.
Footwear Guidance
Recommendations for supportive footwear or orthotics may help reduce pressure beneath the big toe.
Activity Modification
Temporary adjustments to activity levels may help allow the irritated tissues to heal.
Sesamoiditis Treatment in Washington, DC
Pain beneath the big toe can make walking, running, and standing uncomfortable. With the right treatment approach, many people can recover and return to activity.
At Rose Physical Therapy, individualized care focuses on relieving pressure on the sesamoid bones while improving foot strength and mechanics.
If you are experiencing pain under the big toe or symptoms of sesamoiditis, schedule an evaluation at one of the Washington, DC clinic locations:
Farragut North
Friendship Heights
Navy Yard
Rose Physical Therapy provides comprehensive care designed to help patients recover from sesamoiditis and return to comfortable, confident movement.