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Dr. Harvey R. Danciger

When the Smallest Bear the Most

If you work hard to stay fit and active, it can be very frustrating to experience pain in the ball of your foot during or after activity. There are two very tiny bones found beneath the toe joint in the ball of your foot. They are called the sesamoids, and they can succumb under the pressure of intense activity. Sesamoid injuries cause pain under your foot at the base of your big toe.

Your feet are incredibly designed to handle a lot of stress. Whether you are out on the baseball diamond, on the soccer field, hiking a challenging trail, or running a marathon, they do their best to handle the pressure. There are times though when we expect too much of our feet and push things a little too far. It most often happens unknowingly, but our feet do have a limit. Under stress or direct impact, the sesamoids can become inflamed or fractures and result in significant pain and discomfort.

Unable to Bear the Weight

These pea-sized but very important bones play a crucial role, as they enable the big toe to function normally. They absorb weight-bearing pressure, reduce friction inside your foot, and protect tendons from injury. The location of these small bones and their function are what make them vulnerable to injury. If you are a runner, more than half the weight that your feet have to bear goes through the big toe joint and surrounding muscles and ligaments. As much as three times your body weight may be transferring across the sesamoid bones, and they could buckle under pressure. It is more common for these bones to be more at risk for injury if you have high arched feet.

One, Two, Three Strikes You’re Out

Sesamoid injures can be divided into acute and chronic injuries. Acute injuries are traumatic and occur with direct impact or a blow to the foot. Chronic injuries happen over time. The three most common sesamoid injuries include:

Turf Toe – Common among football players who play on artificial turf, this injury occurs when the big toe is extended beyond its normal range of motion. Essentially, it is a severe sprain that causes immediate swelling and pain, but in some cases the sprain can damage the tissues around the sesamoids or cause a fracture in them as well.

Sesamoiditis – This is a chronic injury where increased pressure and stress is put on the bones and they become chronically irritated and inflamed. You may feel a dull, aching pain that comes and goes, depending on your activity level or the shoes you wear. 

Fracture – This can be an acute fracture, which is a break in the bone at the time of trauma to the foot, or a chronic fracture, which is also called a stress fracture. This is a hairline break that slowly develops with repeated stress. Immediate pain and swelling would be experienced with the first, and lingering pain that comes and goes is often associated with the latter.

Treatment for Sesamoid Injuries

We most often need to use an X-ray or other type of bone scan to determine the extent of the damage and the optimal treatment plan. There are many conservative treatment options for an injury to this area of the foot, including rest, icing, physical therapy, anti-inflammatory medications, splinting, orthotics, felt padding for weight dispersion, and rigid soled shoes.

Most often a combination of these efforts are effective in healing this type of injury. While rest and limitation of activities is important, many people can remain ambulatory as long as there isn’t too much weight put on the injury. This full healing process could last 6-8 weeks depending on the severity of the damage.

When you feel pain in ball of your foot, don’t just ignore it, especially if your symptoms are from a traumatic incident.  Our effective care and treatment will get you back to your activities without further foot pain. Contact Harvey R. Danciger, DPM for an appointment or more information. You can reach our Palm Desert, CA office at (760) 568-0108.


Dr. Harvey Danciger
Dr. Harvey Danciger is a podiatrist and foot surgeon in Palm Desert, CA specializing in the foot and ankle