Sesamoiditis · Ball-of-foot pain

Sesamoiditis treatment on the Gold Coast.

Pain at the ball of the foot under the big toe joint? You may be dealing with sesamoiditis — irritation of the two small bones that sit under the big toe. Treatable with the right combination of offloading, footwear changes and (in stubborn cases) advanced therapy.

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What sesamoiditis is and who gets it.

The sesamoid bones are two pea-sized bones that sit under the head of the first metatarsal — the bone at the base of the big toe. They’re embedded in the flexor hallucis brevis tendon and they act like a pulley, increasing the leverage of the big toe push-off during walking and running.

Sesamoiditis is inflammation of those bones or the surrounding tissues. It usually develops gradually with overuse — runners, dancers, people who’ve recently increased high-impact activity, or those whose foot type loads the first metatarsal more than usual (high arch, rigid foot type, splayed forefoot).

Pain is felt directly under the big toe joint, worse with weight-bearing on the ball of the foot, particularly during push-off. Untreated, it can progress to a stress fracture of one of the sesamoids — an injury that’s much harder to fix.

How we treat it

Six elements of sesamoiditis treatment.

Sesamoiditis responds well to conservative treatment when caught early. The longer it’s ignored, the longer it takes.

Offloading with padding or orthotics

A first-metatarsal-head cutout or a metatarsal pad redirects pressure away from the sesamoids. Often the single biggest change.

Activity modification

Reduce running, jumping and high-impact loading temporarily while inflammation settles. Cross-training keeps fitness without re-irritating.

Footwear changes

A stiffer-soled shoe (or carbon-plated insert) limits big toe extension during push-off, reducing the load on the sesamoids.

Anti-inflammatory measures

Ice, topical NSAIDs, and short courses of oral anti-inflammatory medication where medically appropriate. Adjunct to the mechanical work.

Shockwave or laser therapy

For chronic cases where standard care hasn’t shifted the pain. Both have evidence for stubborn sesamoid pain.

Imaging if not responding

If 6-8 weeks of good treatment hasn’t shifted symptoms, we’ll arrange an X-ray or MRI to rule out a stress fracture or osteonecrosis.

How we approach it

Three steps from first visit to outcome.

Assessment.

A 45-minute assessment. Palpation to localise the painful sesamoid, gait analysis, footwear review, and ruling out other causes of forefoot pain (Morton’s neuroma, capsulitis, plantar plate injury).

Treatment plan.

Offloading strategy (padding, orthotic prescription, footwear change) plus activity modification. Most cases respond within 6-12 weeks. Hands-on treatment and adjunct therapies as needed.

Review and progression.

Reviewed every 3-4 weeks. We track pain, function and return to activity. If not responding by 6-8 weeks we re-assess and image. Discharge with a return-to-activity plan.

HICAPS on the spot with every major fund · Medicare GPCCMP, DVA, NDIS & WorkCover accepted where applicable.