As the warmer weather comes upon us, more and more people are returning to running, walking, and outdoor activities. Foot injuries become increasingly more common. A common injury to suffer is pain under the big toe joint. Patients that develop pain, swelling under the big toe joint, and pain during push-off when walking or running should be evaluated for sesamoid injury.
The sesamoid bones are two small bones located under the big toe joint.
Although the sesamoids are tiny bones beneath the big toe joint, they play a critical role in propulsion and shock absorption with every step we take. These bones absorb a tremendous amount of pressure during the push-off phase of gait.
During normal walking, the pressure transmitted through the sesamoid apparatus can reach approximately 2 to 3 times body weight. During running, those forces increase up to 5 to 8 times body weight. This repetitive stress and force under the big toe joint can overload the sesamoids and lead to pain in the ball of the foot, focused under the big toe joint.
A careful evaluation is important to determine the correct diagnosis and treatment plan. A detailed history and physical exam of the big toe joint can pinpoint the exact location of the pain. Standard radiographs are usually the first imaging study obtained. An MRI study is helpful in determining an acute fracture of the sesamoid versus surrounding inflammation around the sesamoid bone.
Conservative treatment options for sesamoid injury include activity modification, padding, orthotics, stiff-soled shoes, or a walking immobilization boot. Early evaluation and appropriate imaging studies are important for achieving the best possible outcome. Delay in treatment of a sesamoid injury can lead to chronic pain under the joint, delayed union of a sesamoid fracture, altered gait mechanics, and long-term joint dysfunction.
If you are experiencing persistent pain in the ball of the foot or beneath the big toe joint, early evaluation with a podiatrist is important to prevent worsening injury and prolonged discomfort.
I am Dr. Joseph A. Cione, board-certified foot surgeon with Advanced Footcare, proudly serving patients in Woodbury, Baldwin, and Manhasset.
