What is it?

The sesamoids are two bones that lie under the base of the big toe. They are part of one of the tendons that pulls the toe downwards. They help to ensure that the tendon pulls in the correct direction in a similar way to the kneecap over the knee. Sometimes they get injured or become inflamed and cause pain.

What causes it?

Normally it occurs as a result of too much pressure on the ball of the foot under the big toe. This may be due to excessively high arches (cavus) or equally due to flat feet. It may also result from unaccustomed exercise. What are the symptoms? Pain is usually the most significant problem. It is felt under the base of the big toe and is worse standing on tiptoe or if the toe is pushed upwards.

How is the diagnosis made?

The doctor will listen to the description of the symptoms and will examine the foot and ankle. Plain X-rays are helpful to look at the sesamoids and the rest of the foot. Sometimes it is necessary to have an MRI or ultrasound scan to make the diagnosis.

What is the initial treatment?

Off-loading the area with insoles (orthotics) tailored specifically to help the underlying cause are usually very successful in resolving the problem.

If initial treatment doesn't work, what's next?

Occasionally it is helpful to inject the area with a small amount of steroid. Surgery is very rarely required, but can be used either to rebalance the foot or remove the sesamoid altogether.

Our practice covers the following hospitals:

Parkside Hospital
For appointments phone : 0208 971 8026

St Anthony's Hospital
For appointments phone : 0208 335 4678

Ashtead Hospital
For appointments phone : 01372 221441

New Victoria Hospital
For appointments phone : 0208 9499000

Clock House Hospital
For appointments phone : 01372 840837