Sesamoiditis: Pain under the base of your big toe

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

The foot is a very complex piece of biomechanical engineering and there are many causes of pain under the base of the big toe joint.  Pain in this area is one of the most common conditions that our podiatrists see in the clinic presenting to them.This article should help you to understand the basic causes of pain under the foot and why it is something that you should not ignore.The foot is comprised of 29 bones in each foot, including the small sesamoid bones in the foot.  When you come to think about how many bones there are in the human body thats over a quarter of the bones of the body being in the feet.

There are 206 bones in the human body.  Some people can have extra bones which are another source of pain in the foot.  These can be in awkward places in the foot and become very irritated due to mechanical irritation on the extra bone, tendons around the joint and the joint its-self.If you would like more information about this from our podiatrists then please don’t hesitate to contact us or use the enquiry form on this page.

If you would like more information about this from our podiatrists then please don’t hesitate to contact us or use the enquiry form on this page.

Each of the bones in the foot have a different name which helps us to localise them and find them again in the foot, when there are so many its easy to get lost!

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?

If you are suffering with pain under the big toe then you may have one of several conditions.  Normally these are easily diagnosed and easily given advice on.  Making sure a thorough case history is taken is key to understnading why there is pain under the big toe.
There a few common conditions which can result in pain in this area.  Here are the main conditions we see in clinic everyday which people often complain of
  • Gout
  • Bunions
  • Fractured Sesmoid bones
  • Tendonitis
  • Mortons Neuroma (not quite under the big toe)
  • Fractured Phalanx
  • Osteo-arthritis
  • Rheumatoid Arthritis
  • Sesamoiditis
A clear diagnosis and history taking are essential to understnading what the cause is of your pain under the big toe.

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

Thankfully there are several things that you can do at home to reduce pain under the big toe until you can get to see someone.  They are very easy and will releave most types of pain under the big toe until a more clear diagnosis can be made.
The majority of the conditions results from mechanical overload.  If you think your foot has been stressed and resulted in pain underneath the big toe then you should consider the following questions…
  • 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?


How can we help?

If you would like any further help, please contact us using the form below.

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