Pain underneath the great toe can be a result of injuries to the sesamoid bones. These 2 semilunar-shaped bones are located beneath the head of the 1stmetatarsal and function similarly to kneecaps. These small bones that play an important role in the functionality of your toes by helping to absorb weight-bearing pressure at the joint, reducing friction at the metatarsal head and protecting the tendon that flexes the great toe.
A person experiencing sesamoiditis would experience pain beneath the head of the great toe. Pain is usually worse with walking or running and may be exacerbated when wearing high-heels or thin-soled shoes. Trauma to the sesamoids or positional changes of the bones due to biomechanics or foot structure may lead to pain. Sesamoiditis occurs more frequently in those with high-arched feet or people with bunions. Dancers and joggers also commonly experience sesamoiditis.
When examining your foot, your podiatrist will examine each sesamoid and the range of motion at the joint. Usually the tibial sesamoid, the more medial bone, will be more painful than the fibular sesamoid. If the joint is swollen your podiatrist may aspirate the joint to rule out gout or septic arthritis. There may be a callus or corn in the area, exacerbating or producing the pain. Your foot doctor may order x-rays to evaluate for possible fracture, displacement, or arthritis.
Conservative treatment for sesamoiditis include shoe gear changes to shoes with a thick sole and orthotics that would reduce pressure on the sesamoids. Corticosteroid injections may be offered to help reduce pain and inflammation. In the case of fractured sesamoids or refractory sesamoiditis, foot surgery to remove the sesamoids may be indicated. Call your podiatrist today if you have questions or concerns about sesamoid injuries.