Sesamoiditis: Overview, Signs, Causes, and Treatment at PhysioActive
What is Sesamoiditis?
Sesamoiditis is an inflammation of the sesamoid bones and the surrounding tendons, typically affecting the small bones under the big toe (hallux). These bones act as pulleys to improve movement efficiency but can become irritated due to excessive pressure or overuse.
Signs & Symptoms
- Pain beneath the big toe joint (ball of the foot), especially when weight-bearing.
- Swelling and tenderness around the first metatarsophalangeal (MTP) joint.
- Increased pain with activities like walking, running, or jumping.
- Difficulty pushing off during gait or while wearing high heels.
- Possible callus formation under the affected area due to abnormal pressure distribution.
Causes of Sesamoiditis
- Repetitive impact activities (e.g., running, dancing, basketball).
- Excessive pressure on the forefoot (e.g., wearing high heels, walking barefoot on hard surfaces).
- Foot structure issues (e.g., high arches, bunions, or forefoot instability).
- Inadequate footwear (e.g., shoes with poor arch support or thin soles).
- Tight calf muscles or Achilles tendon (increases pressure on the forefoot).
How PhysioActive Treats Sesamoiditis
At PhysioActive, treatment focuses on reducing pain, restoring foot mechanics, and preventing recurrence.
1. Pain Management & Load Reduction
- Activity Modification:
- Avoid high-impact activities temporarily.
- Modify gait mechanics to offload pressure from the sesamoid bones.
- Manual Therapy & Soft Tissue Mobilization:
- Myofascial release for tight calf muscles and intrinsic foot muscles.
- Joint mobilization to optimize first MTP movement and improve foot mechanics.
- Orthotic Support & Padding:
- Custom foot orthotics with a sesamoid cutout to relieve direct pressure.
- Metatarsal pads to redistribute weight across the forefoot.
- Footwear assessment to ensure proper support.
2. Strengthening & Isometric Loading for Tendon & Foot Stability
- Isometric Toe Flexion Holds (Pain Management)
- Press big toe against resistance without movement, holding for 30-45 sec.
- Helps reduce pain by stimulating tendon adaptation.
- Intrinsic Foot Muscle Strengthening
- Toe curls with a towel – Improves foot arch support.
- Short foot exercise (“Doming”) – Strengthens medial longitudinal arch.
- Calf Strengthening & Ankle Stability Training
- Seated and standing calf raises (progressively loaded).
- Single-leg balance drills for proprioception and foot control.
3. Shockwave Therapy (For Chronic or Non-Healing Cases)
- Stimulates blood flow to improve tendon healing.
- Reduces pain and inflammation by triggering a biological healing response.
- Helps remodel scar tissue in chronic cases.
4. Return to Activity & Prevention
- Gradual Return to Running & Impact Sports
- Modified loading strategies to reduce forefoot stress.
- Running gait analysis to optimize landing mechanics.
- Education on Footwear & Load Management
- Shoes with cushioned soles & wide toe box recommended.
- Avoiding excessive forefoot loading through proper movement mechanics.
💡 Surgical Referral:
If conservative treatment fails or if there is sesamoid fracture or necrosis, referral for advanced imaging or surgery may be considered.
Why Choose PhysioActive for Sesamoiditis?
- Expert Manual Therapy to improve foot biomechanics and mobility.
- Custom Orthotic Support & Gait Training to offload pressure from the sesamoid bones.
- Isometric & Strength-Based Rehabilitation for long-term tendon health.
- Shockwave Therapy Available for chronic, non-healing cases.
