Sesamoiditis & Sesamoid Injuries

Common Symptoms

• Pain directly under the big toe joint, worse with push-off or standing on the toes
• Pain that worsens with high heels or thin-soled shoes
• Swelling or tenderness under the ball of the foot
• Difficulty bearing full weight through the big toe

Why It Happens

Repetitive weight-bearing stress on the sesamoid bones — from running, dancing, or activities involving a lot of forefoot loading — can cause inflammation (sesamoiditis), a stress fracture, or, less commonly, a loss of blood supply to the bone (osteonecrosis).

Why It Can Become Persistent

The sesamoids bear significant load with every step, so ongoing walking and standing can continue to aggravate the area unless load is meaningfully reduced.

Who Commonly Gets It

Sesamoiditis is especially common in runners, dancers, and people who wear narrow or high-heeled shoes regularly, and in people with a naturally higher foot arch.

How It Is Usually Diagnosed

Diagnosis involves history, exam, and X-ray; MRI or CT may be used if a stress fracture or osteonecrosis is suspected, since that distinction affects treatment.

Traditional Treatment Options

• Offloading padding or orthotics: Redistributing pressure away from the sesamoids is a foundational first step.
• Activity modification and stiff-soled shoes: Reducing forefoot loading during flare-ups.
• NSAIDs: Sometimes used for symptom control.
• Immobilization: May be used for a suspected stress fracture, per your provider's guidance.
• Surgical excision: Removal of a sesamoid bone, reserved for cases that don't respond to conservative treatment.

Why Someone Might Start Looking for Another Option

When offloading and activity changes don't fully resolve symptoms, people look for additional non-surgical options — shockwave therapy is one that's been explored, though the evidence specific to this area is very limited.

Where Shockwave Therapy May Fit

We want to be direct here: the only evidence we could independently verify is a single case report of a patient with imaging-confirmed sesamoid osteonecrosis (loss of blood supply to the bone) — a specific and less common cause of sesamoid pain — who improved with radial shockwave therapy and returned to sport with no recurrence at 1 year. This is real, but it's the weakest form of clinical evidence, describes a specific diagnosis rather than sesamoiditis broadly, and cannot establish how often this approach works.

How Shockwave Treatment Works for This Area

If considered appropriate after imaging confirms the diagnosis, acoustic pressure waves would be applied to the affected area, generally alongside offloading and footwear changes.

What the Treatment Feels Like

Most patients describe a firm tapping or pressure sensation under the ball of the foot, which can be quite tender given the weight-bearing location; your provider will discuss what to expect.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not yet had imaging to clarify the specific cause of sesamoid pain
• A suspected acute sesamoid fracture, which may need immobilization rather than shockwave therapy
• Active infection, open wounds, or certain bone conditions at the treatment site

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.