Sesamoiditis: Painful Pulleys

In Colorado, we have all kinds of opportunities to go rock climbing. A pulley system is an essential tool used to propel you downward—without it you could be stuck between a rock and a hard place! Sesamoid injuries are similar. The tiny bones beneath the big toe joint act as pulleys to move your toe and provide leverage when you push off from your step. Damage to these bones and the surrounding tissues—a condition called sesamoiditis—can be painful and debilitating.

Signs of SesamoiditisGetting a Grip on the Condition

Sesamoid bones are actually embedded in muscle, providing a smooth surface for tendons to slide (like a pulley). The two located in your foot are about the size of a corn kernel and can be found in the ball of the foot near your big toe. Besides providing the ability to move your toe and propel you forward, these bones bear your weight, making them prone to injury.

The Cause Behind Your Ascending Pain

Sesamoid injuries are mainly associated with activities that place an excessive amount of pressure on the forefoot such as basketball, ballet, running, football, tennis, golf, and squatting like a baseball catcher. Those with high arches or who often wear high heels are also highly susceptible. There are three types of sesamoid injuries that can occur in the foot:

Turf Toe—This occurs when the big toe joint is hyperextended, moving beyond its normal range. The surrounding soft tissue can be damaged and the sesamoids fractured, causing pain, swelling, and limited mobility.

Acute or Chronic Fractures—An acute fracture is caused by a direct blow, resulting in immediate pain at the site of the break. A chronic fracture is a hairline break (stress fracture) producing long-lasting pain that tends to come and go with activity and rest.

Sesamoiditis—This is a form of tendinitis, since damage to the bones is often accompanied by inflamed and irritated tendons. An overuse injury, it occurs when repetitive stress is placed upon the area. Pain develops gradually. Continued use aggravates the problem, while rest relieves it.

To determine what type of sesamoid injury you have, the doctors at Podiatry Associates, P.C. will examine the area and manipulate the big toe by pressing and moving it to determine points of pain. We may also observe your walk and evaluate the wear of your shoes. An X-ray will help to determine the type and extent of the injury. Once this is done, we can discuss appropriate treatment options.

Descending from Discomfort

Cease any activities that are causing you pain. While resting the foot, ice the area to minimize swelling and discomfort. You may need to tape or splint your big toe, or wear a walking boot to keep it immobilized. If you are able to wear shoes, opt for a pair with stiff soles. Use padding to alleviate pressure. We may prescribe orthotic inserts to help distribute weight more evenly, as well as anti-inflammatory medication taken orally or injected. Finally, physical therapy exercises and ultrasound can help to restore range of motion and strength. Return to activities gradually, avoiding those that put excessive pressure on the balls of your feet.

If sesamoid injuries fail to respond to these conservative treatments, a surgical procedure may be required.

Rock Solid Help

If you think you may be experiencing sesamoiditis, or have any other foot pain, contact Dr. Oberholtzer-Classen and the team. To set up an appointment, call (303) 805-5156, or visit one of our Podiatry Associates, P.C. locations in Parker and Castle Pines, CO.

Photo Credit: Satit_Srihin via

Dr. Cynthia Oberholtzer-Classen, DPM
Founder and Owner of Podiatry Associates, PC