Sesamoiditis: Pain under the base of your big toe

Do you suffer from pain under the base of your big toe?

Understanding basic foot mechanics and why we get pain under the big toe

The foot is dividided up into 3 regions which make it easier to descibe the location of pain when seeing a specialist.  The rear foot is made up of the heel bone (Calcaneus) and the bone which connects the heel bone to the rest of the body (Talus).  There are other bones which make up the rear foot (Navicular and Cuboid).The rearfoot is a very strong part of the foot and

The rearfoot is a very strong part of the foot and is therefore a very important part of force transmission and absorption of force when the heel hits the ground.  Ground reaction forces can be as much as 8 times your own body weight when you are running.

So the heel has to be a well designed piece of kit to allow this to happen.  We have other articles on pain in the rear foot if you would like to read these just let us know.

The mid foot is an area key to accomodating to the ground and shape of the ground under foot.  The bones are specially designed to absorb mechanical forces directed through the rear foot into the fore foot.  The accomodation effect allows a twisting motion called pronation and supination to occur.  Much contrary to popular belief pronation is not a bad thing.

Many shoe manufacturers make huge sales of shoes to help stop pronation.  If pronation did not occur in the foot then the motion of the foot would not be as smooth as it is with this vital composite of movement.  The foot would be very stiff indeed.  Going over un-even ground would be like driving over a rocky path with hard tyres, you’d feel everything!

Problems occur when pronation is excessive or minimal.  Seeing someone who can diagnose which you have can help isolate the cause of your problem. Pain may also appear in the arch of the foot if you have a problem with pronation or supination.  This is a very common complaint that we see.  Often people leave this for months, sometimes years and have to deal with the consequences.

It is normaly easily treated and will not return if treated properly. The forefoot is an intergral part of the foot, despite not forming much of the weight bearing component of the foot, it has some other interesting functions.  The main weight bearing areas of the forefoot are the outer two bones.  The arch shape of the foot allows the middle sections in the foot to remain raised.

There are other arches in the feet which allow the central section of the mid foot to stay high off the ground.  The base of the big toe therefore is an area of high mechanical load.  This is an important fact to remember when understanding why we get pain under the big toe joint.

During the later phases of the gait cycle (walking cycle) the base of the big toe acts as a lever to propel the entire body weight (balanced above it) off one foot and onto the other foot.  The base of the big toe is specially designed to allow this to happen naturally and with great efficiency.  When there are obstructions to this movement we end up with pain.

Why do you get pain under the base of the big toe?

Beneath the head of the first metatarsal, otherwise known as your big toe, are two small bones called the sesamoid bones. These are small bones, approximately the size of a small pea. Their job is to essentially help to manage the load and pressure at the base of the big toe and then distribute it when you walk and run.

Sometimes these bones can become bruised and/or the area can become inflamed, making walking uncomfortable: this is known as Sesamoiditis. This injury normally occurs when landing incorrectly from a jump, but can also occur from someone who repetitively works on hard-floor surfaces.

Sesamoiditis results in localised pain and sometimes swelling around the sesamoid bones. The injury is often slow to heal but a combination of ice, ultrasound and a felt padding under the base of the big toe have been found to be effective at aiding recovery.Occassionally the load under the big toe can become so excessive that the sesamoid bone’s fracture and this can be very painful and often difficult to diagnose.

The pain is often very acute and very localised there is often a history of excessive running, poor nutrition, poor foot wear, barefoot running or landing heavily on the foot when jumping.  The diagnosis is not an easy one to make.

What to do if you have pain under the big toe?

• Gout
• Bunions
• Fractured Sesmoid bones
• Tendonitis
• Mortons Neuroma (not quite under the big toe)
• Fractured Phalanx
• Osteo-arthritis
• Rheumatoid Arthritis
• Sesamoiditis

What you can do if you have pain under the big toe?

• Are the shoes I am wearing putting too much pressure on the ball of my big toe? (high heel shoes and mens dress shoes can all contribut to this)
• Am I walking or on my feet most of the day?
• Does the pain underneath my big toe get worse when I walk?
• Have I got any redness or swelling around the joint that is painful?