Merck Manual

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Kendrick Alan Whitney

, DPM, Temple University School of Podiatric Medicine

Last full review/revision Dec 2019| Content last modified Dec 2019
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Sesamoiditis is pain around the two small bones (the sesamoid bones) below the metatarsal head where it adjoins the big toe (first metatarsal head).

  • Symptoms include pain when walking while wearing certain types of shoes.

  • The diagnosis is based on an examination of the foot.

  • Orthoses and new shoes can help relieve pain.

Sesamoiditis is a common cause of pain in the ball of the foot (metatarsalgia).

The cause of sesamoiditis is usually repeated injury. Sometimes the bones are fractured (see Figure: Where Foot Fractures Occur), or the bones or surrounding tissues are inflamed. A change in the structure of the foot can sometimes shift the position of the sesamoids (displacement) and cause pain.

Sesamoiditis is particularly common among dancers, joggers, and people who have high-arched feet or frequently wear high heels. Many people with bunions have sesamoiditis.


The pain of sesamoiditis is felt beneath the base of the big toe (the first metatarsal joint). The pain is usually made worse by walking, particularly when wearing certain flexible thin-soled or high-heeled shoes. The area may be warm and swollen, and the big toe may be red.


  • A doctor's examination of the foot

  • For gout or infection, joint aspiration

  • For fracture, displacement, or arthritis, imaging tests

The doctor bases the diagnosis of sesamoiditis on an examination of the foot.

The doctor uses a needle to remove a sample of joint fluid (called joint aspiration or arthrocentesis) if gout or infectious arthritis is suspected.

X-rays are taken and sometimes magnetic resonance imaging (MRI) is done to rule out arthritis, displacement, or a fracture of the sesamoid bone.


  • New shoes

  • Orthoses

Not wearing the shoes that cause pain may be sufficient. If symptoms continue, however, shoes with a thick sole, low heels, orthoses (devices placed in the shoe), or a combination help by reducing pressure on the sesamoid bones.

A nonsteroidal anti-inflammatory drug (NSAID) taken by mouth and injections of a corticosteroid/anesthetic mixture into the affected area can help relieve pain.

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