Painful Sesamoid

Foot & Ankle Conditions

1. Ankle Instability
2. Ankle Impingement
3. OCD of Talus
4. Foot Drop
5. Arthritis around Ankle


1. Insertional Achilles Tendinosis
2. Haglund's deformity
3. Planter Fasciitis
4. Other cause of heel pain


1. Flat foot/Pes planus
2. High Arched foot/Cavus foot/ Pes cavus
3. Mid foot Arthritis
4. Stress fracture
5. Planter fibromatosis
6. Deformity of Foot Arch
7. Accessory Navicular


1. Hallux valgus/Bunion
2. Hallux rigidus
3. Hallux varus
4. ingrowing toenail
5. Painfull sesamoids
6. Arthritis around Great Toe


1. Mallet toe
2. Hammer toe
3. Claw Toe
4. Bunionet


1. Complex deformities- cross over toe, Rheumatoid foot
2. Athlets feet
3. Corn's & Callosities
4. Morton's Neuroma
5. Metatersalgia


1. Non insertional Achilles Tendinosis
2. Achilles Tendon Injury / rupture
3. Tibialis Posterior Tendon Dysfunction
4. Flexor Hallucis tendon irritation
5. Peroneal Tendinopathy


1. Ankle Sprain
2. Ankle Fractures
3. Talus fracture
4. Calcaneum Fracture
5. Lisfranc's Injury
6. Midfoot fracture
7. fracture metatersal neck
8. Turf Toe injury

Painful Sesamoid

There is two sesamoid bone within the tendon of flexor hallusis brevis articulates with 1st metatarsal and forms part of planter plate. Function of sesamoid is to distribute weight bearing of 1st ray and stabilizes it. A verity of condition can cause a painful sesamoid. It can be acute or chronic and extremely disabling. Identifying the cause of the pain and differentiating it from cause other than sesamoid origin is difficult. Modern imaging is very helpful is diagnosis.

  • Following conditions can cause a painful sesamoid
  • Stress fracture
  • Acute fracture
  • Turf toe injury
  • Sesamoiditis
  • Osteochondritis dissecans
  • CHondromalacia
  • Osteoarthritis

There are few risk factors that can aggravate the condition

  • Obesity
  • High arched foot
  • Walking on high heel
  • Participation of high impact sports like volleyball, running, gymnastics
  • Osteoarthritis
  • Osteoporosis
  • Walking on high heels
  • Higher arches, flattened arches, bony feet.
  • Increased in body weight
  • Bigger the size of the sesamoids, higher the risk.
  • High impact sports like volleyball, running, gymnastics, etc
  • Pain and swelling around big toe
  • Difficulty in movement of big toe
  • Bruising may or may not be present

Pain at ball of great toe along with difficulty in weight bearing and push off are the key sign to visit a specialist foot and ankle surgeon.

He will analysis your symptom to find the source of pain then he will do a detail clinical examination to confirm the tender point. He mas ask you to get some special view of x-ray for sesamoid as well as MRI and bone scan to conclude diagnosis.

Most of the conditions of sesamoid are self-limiting which need supportive treatment aiming pain relief and improve activity.  These conservative treatments are,

  • Soft tissue massage
  • Ultrasound
  • Soft padding for shoes and custom made insole
  • Avoiding painful activities
  • NSAIDs
  • Local infiltration with corticosteroid and PRP

In refractory conditions and acute condition like fracture and planter plate injury need surgical intervention

  • Sesamoidectomy is excision of sesamoid
  • Fixation of acute sesamoid fracture
  • Plater plate repair