Sesamoiditis: A Physiotherapy Guide

What is Sesamoiditis?

Sesamoiditis is a clinical diagnosis that generally refers to pain in one or both of the hallux sesamoids (the medial and lateral sesamoids). The condition is often linked to overuse or repetitive trauma.

The hallux sesamoids are small, round bones located plantar (underneath) to the first metatarsophalangeal (MTP) joint. Functionally, they are crucial because they distribute weight-bearing forces onto the first ray and act as a fulcrum to enhance the leverage and strength of the flexor hallucis brevis tendon. During normal walking (ambulation), the sesamoid complex supports up to 50% of the body weight. Sesamoiditis can involve inflammation of the peritendinous structures surrounding the sesamoids.

Prevalence in Athletics

Sesamoid injuries and pain, including sesamoiditis, are particularly debilitating and detrimental to athletes involved in activities that place high stress on the forefoot, such as running and jumping athletes. This is because the sesamoid complex supports more than 300% of body weight when pushing off in athletic activity.

Specific athletic populations frequently affected include:

• Runners: Runners are at high risk because the repetitive push-off forces during running place substantial stress on the sesamoids, especially in forefoot strikers, those training on hard surfaces, using minimalist footwear, or increasing mileage too rapidly.
• Dancers: Dancers are known to be especially susceptible to forefoot injuries, including sesamoiditis, due to repetitive activities.
• Athletes in forefoot loading sports: Activities involving repetitive extension of the big toe, such as jumping, tennis, and ballet, can cause overuse of the sesamoids and their supporting structures.

Common Symptoms

The primary symptom of sesamoiditis is pain. This pain is typically experienced in the plantar aspect of the forefoot, specifically under the big toe, associated with the sesamoid bones.

Common symptoms noted in those with sesamoiditis include:

• Pain during weight-bearing.
• Pain upon direct palpation of the sesamoids.
• Pain with passive extension of the first MTP joint.
• Forefoot swelling.
• Localised tenderness.
• Decreased extension of the first MTP joint.

If chronic sesamoiditis is left untreated, it may lead to scarring of the tendons, ligaments, and capsule of the sesamoid complex, which can limit the motion of the sesamoids, resulting in further pain and a loss of range of motion (ROM).

Anatomy of the Sesamoids: Why These Tiny Bones and Their Tendons Matter

The development of pain in the hallux sesamoid region (sesamoiditis or hallux sesamoid syndrome) stems directly from the critical weight-bearing and biomechanical roles of its components, making them highly susceptible to repetitive stress and trauma.

The anatomy of the first ray dictates why injury leads to pain and dysfunction:

1. Sesamoid Bones: The hallux sesamoids are two small, round bones (medial and lateral) located on the plantar aspect (underside) of the first metatarsophalangeal (MTP) joint, which connects the great toe (hallux) to the rest of the foot.
2. Location and Support: These bones are essential components of the forefoot structure. The sesamoid complex distributes weight-bearing forces onto the first ray. The first metatarsal itself forms the distal aspect of the medial longitudinal arch.
3. Tendons and Leverage: The sesamoids act as a fulcrum to increase the leverage and strength of the flexor hallucis brevis tendon. The flexor hallucis brevis is one of the muscles strengthened in physical therapy to improve forefoot and sesamoid function.
4. Supporting Structures: The first MTP joint, where the sesamoids are located, is supported by the joint capsule, collateral ligaments, and the plantar plate. The plantar plate is a fibrocartilaginous structure running from the metatarsal head to the proximal phalanx, which helps support the transverse arch and serves as an attachment point for the plantar fascia.

How Does Sesamoiditis Develop? Causes and Risk Factors

1. Activity Overload and Repetitive Forefoot Pressure

• Athletic Overload: The sesamoid complex supports more than 300% of body weight when pushing off in athletic activity. This high stress leads to sesamoid injury.
• Specific Risk Activities: Sesamoid injuries are frequently overuse injuries. Activities involving repetitive extension of the great toe, such as running, jumping, tennis, and ballet, stress the sesamoids and their supporting structures.
• Athlete Population: Runners, including marathoners, and dancers are highly represented in populations suffering from sesamoid injuries, highlighting the connection between repetitive, weight-bearing training and the development of pain.
• Tissue Irritation: Chronic sesamoiditis, if left untreated, can lead to scarring of the tendons, ligaments, and capsule of the sesamoid complex, which limits motion and results in further pain and loss of range of motion. The initial overuse and trauma are responsible for the inflammation of the peritendinous structures of the sesamoids.

2. Biomechanical Factors (Foot Type and Alignment)

Abnormal foot alignment negatively affects lower extremity biomechanics and increases the risk of forefoot pathology, including sesamoiditis.

• Abnormal Supination (Pes Cavus/High Arch): Individuals diagnosed with an abnormal supination movement system disorder may be at risk of overloading the sesamoids. This foot type is typically more rigid and is associated with a high arch and a plantar flexed first ray. This rigidity reduces the foot’s ability to attenuate (absorb) weight-bearing stressors, directing excessive force onto the forefoot and sesamoids.
• Metatarsalgia/Overloading: Sesamoid pain falls under the category of forefoot pathologies where repetitive overloading of the metatarsal head(s) occurs due to anatomical or biomechanical abnormalities.

The sesamoids are like the wheels of a pulley system on a major suspension bridge (the foot's arch) that must bear tremendous, repetitive traffic (body weight). When the wheels or the ropes (tendons and ligaments) supporting them become inflamed or scarred due to constant friction and excessive load, the entire system breaks down, resulting in debilitating pain and functional loss.

3. Training Errors

• Rapid Increase in Training Intensity: Metatarsalgia (general forefoot pain) is noted to result from repetitive overloading due to factors like a rapid increase in training intensity. Since sesamoiditis is categorized as an overuse injury and bone stress injury is a common accompanying pathology, sudden increases in weight-bearing activities and training intensity are primary risk factors.
• Inappropriate Footwear: Improper footwear is a contributing factor to the overloading of metatarsal heads, which can cause forefoot pain. Footwear modifications, such as rigid shoes and orthotics, are initial treatments used to offload the sesamoids, indicating that inappropriate shoes can contribute to the injury.

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Physiotherapy Treatment Approaches for Sesamoidits

Physical therapy (PT) for sesamoiditis and chronic hallux sesamoid injuries integrates several approaches, often referred to as a movement system approach, which shifts treatment focus from the pathoanatomical diagnosis to correcting underlying impairments and abnormal movements. PT typically combines manual therapy with progressive exercise and functional retraining.

Progressive Strengthening of Hallux Flexors

Strengthening the flexor hallucis muscles is crucial for stabilising the first MTP joint during heel rise and improving forefoot function.

Specific Flexor Strengthening: Techniques involve both isometric and isotonic contractions.

• Isometric Training: Patients perform isometric contractions (e.g., 10 repetitions with a 10-second hold) with the floor or manual resistance.
• Isotonic Training: The therapist provides manual resistance through the great toe's range of motion, short of stopping movement.
• Benefits: The addition of flexor hallucis strengthening, combined with sesamoid mobilisation and gait training, resulted in a statistically significant increase in flexor hallucis strength, whereas a general PT program alone did not.

Functional Gait Retraining and Calf Strengthening

Functional retraining ensures the corrected mechanics are integrated into everyday movement, which helps prevent recurrence of the overuse injury.

• Gait Training: This involves providing verbal cues (e.g., "Push your big toe down into the ground now and propel yourself forward") as the heel begins to rise to reinforce the functional use of the hallux flexors. This re-educates the muscles on how to function under weight-bearing conditions.
• Calf Strengthening: Heel raises are performed for calf strengthening to support the propulsive phase of gait, where the forefoot must withstand high loads.

Specific Strengthening Exercises for the Intrinsic Foot and Calf Complex

Physical therapy prioritises progressive exercise, based on the foot core paradigm, which emphasises intrinsic plantar foot muscle strengthening and the stabilisation of the first ray.

• Short Foot Exercises (Foot Doming)
  • Focus on actively elevating the medial longitudinal arch while maintaining contact of the great toe with the ground
  • Targets the intrinsic plantar muscles of the medial longitudinal arch
  • Enhances foot core stability, improves gait mechanics, and supports efficient push-off
• Flexor Hallucis Brevis Activation (Toe Yoga)
  • Involves lifting the great toe while keeping the lesser toes grounded, and then reversing the movement
  • Specifically strengthens the flexor hallucis brevis
  • Improves forefoot and sesamoid function and stabilises the first metatarsophalangeal (MTP) joint during heel rise
• Calf Strengthening
  • Performed through progressive heel raises
  • Prepares the forefoot to tolerate high loading demands during the propulsive phase of gait
  • Supports effective force transfer during push-off
• Other Intrinsic Foot Strengthening
  • Toe-spreading exercises promote abduction of the toes
  • Strengthens the abductor hallucis muscle

These strengthening exercises are typically initiated in a seated position and gradually progressed to standing.

Stretching and Mobility Techniques

PT includes stretching and mobility work to counteract the stiffness and restriction that often follow chronic sesamoid injury, which can lead to scarring of the tendons, ligaments, and capsule of the sesamoid complex.

• Limited First MTP Joint Mobility (Great Toe Extension)
  • Passive range-of-motion exercises are applied to the first MTP joint for approximately 1 minute
  • Grade III dorsal glides and joint distraction are performed for an additional 1 minute to promote extension
  • Aims to restore the 60°–65° of first MTP extension required for normal gait and effective push-off
• Calf Tightness
  • Standing gastrocnemius stretching is performed with the foot positioned in subtalar joint neutral
  • Supine hamstring stretching is also incorporated
  • Improves sagittal plane motion at the ankle and hip
  • Reduces compensatory stress placed on the first MTP joint during gait
  • Identification and correction of ankle dorsiflexion ROM limitations is considered a primary treatment focus
• Plantar Tissue Tension
  • Although not a primary focus in the referenced study protocol, adjunctive modalities such as hot whirlpool therapy and pulsed ultrasound were applied to the plantar surface of the first MTP joint
  • These interventions aim to increase soft tissue extensibility
  • Marble pick-up exercises may also contribute to improved toe mobility and plantar tissue compliance

Manual Therapy and Soft Tissue Release

Manual therapy is a core component of PT for sesamoiditis, specifically targeting the mobility of the bones and joint structures to restore normal biomechanics.

• Sesamoid Mobilisation: The therapist performs Grade III joint mobilisations on the medial and lateral sesamoids of the affected first MTP joint. This involves distal glides by placing a thumb on the proximal aspect of the sesamoid and applying a proximal to distal force to the end range of available motion, followed by large-amplitude rhythmic oscillations. This technique is believed to restore the pulley mechanism for the hallux flexors, which may be damaged by limited sesamoid motion.
• MTP Joint Mobilisation: This includes manual joint manipulation techniques such as axial distraction of the first MTP joint, dorsal glides, and plantar glides to further improve mobility.
• Targeted Soft Tissue Techniques: PT may include soft tissue release (such as to the plantar fascia or flexor hallucis brevis), as techniques like manual joint manipulation and sesamoid mobilisation are intended to overcome scarring in the capsuloligamentous structures and conjoined tendon surrounding the first MTP joint and sesamoid mechanism, which limits motion.

Biomechanical Assessment: Identifying the Root Cause

A comprehensive assessment of the entire lower quarter is essential to identify the factors contributing to the stress and strain on the hallux sesamoids, shifting the focus from the pathoanatomical diagnosis to an impairment and movement-focused treatment.

• Gait Analysis and Functional Movement
  • Emphasis on load distribution and toe-off mechanics
  • The forefoot is the most distal weight-bearing segment and experiences high stress during gait
  • The sesamoid complex supports up to 50% of body weight during normal walking and more than 300% during athletic push-off
  • Abnormal forefoot or lower-extremity biomechanics during propulsion can increase stress on the sesamoids and contribute to pathology
• Foot Posture and Alignment
  • Assessment of abnormal loading patterns using tools such as the Foot Posture Index–6 (FPI-6)
  • Classification of foot type as excessively pronated or supinated
  • An abnormal supination movement system diagnosis—often associated with a high arch, rigid foot, laterally rotated lower extremity, and a plantarflexed first ray—may increase sesamoid loading
  • Reduced shock absorption in these foot types limits the ability to attenuate weight-bearing forces
• Mobility Assessment
  • Focus on first metatarsophalangeal (MTP) joint mechanics
  • Evaluation of great toe extension ROM in both weight-bearing and non–weight-bearing positions
  • Assessment of first ray and sesamoid mobility
  • Sesamoiditis commonly presents with restricted first MTP extension and impaired first ray mobility
• Functional Strength Assessment
  • Identification of muscle imbalances affecting forefoot stability
  • Assessment of strength in the flexor hallucis longus and brevis
  • Weakness of intrinsic foot muscles may be present in chronic forefoot conditions and can compromise first MTP joint stabilisation during push-off

Load Modification & Offloading Strategies

A core component of non-operative management for sesamoiditis is immediate offloading to reduce symptoms and protect the painful first metatarsophalangeal (MTP) joint. The goal is to reduce the immense stress placed on the sesamoid complex, which supports up to 50% of body weight during normal gait.

Modifying Footwear and Offloading Devices

Initial management often includes modifications to footwear and the use of specific devices to mechanically reduce pressure on the sesamoids.

Taping Techniques to Unload the First MTP

Taping is used to influence the mechanics and stability of the forefoot, decreasing shear forces on the sesamoids.

• Improving Position and Function: Taping of the sesamoids can help improve forefoot position and function and may decrease shear forces on the sesamoids and the plantar aspect of the forefoot.
• Correcting Malposition: If assessment identifies decreased sesamoid mobility or abnormal position (e.g., laterally displaced sesamoids), corrective sesamoid mobilisations and/or taping can be implemented. For example, sesamoid taping to correct for laterally displaced sesamoids involves manually repositioning the sesamoids and applying 0.75" leukotape from the dorsomedial aspect of the forefoot to the plantar aspect to stabilize them.

Reducing Impact and Activity Modification

Reducing the load and impact on the sesamoids is critical, especially since the complex supports over 300% of body weight when pushing off in athletic activity.

• Activity Restriction: Activity modification is a primary element of initial, non-surgical management. Patients with severe injuries like bone stress injury (BSI), avascular necrosis, or pain interfering with gait are instructed on specific activity restrictions or offloading during initial treatment.
• Offloading During Severe Injury: For high-risk injuries, this may involve non-weight bearing with crutches or protected weight bearing with a pneumatic boot.
• Avoiding High-Impact: Those with BSI were typically instructed to refrain from high-impact activities like running.

Gradual Return-to-Activity Plan

A return-to-activity plan is implemented once symptoms have decreased and functional gains (strength, mobility) have been achieved through physical therapy (PT). The goal is to progressively re-introduce load tolerance without causing recurrence of pain.

• Timing of Return: Non-operative management has demonstrated good clinical results, with one systematic review noting an 86% return to activity. For chronic cases treated with advanced non-operative methods (like focused shockwave therapy and PT), functional gains were observed over a median follow-up of 11 weeks. One pilot study reported an average return to activity at 10 weeks.
• Load Tolerance During Treatment: Some patients with less severe sesamoiditis may be allowed to continue activities as tolerated during treatment. Athletes undergoing treatment can often participate in training or competition if the pain is tolerated, as the treatment carries minimal risk.
• Progressive Re-introduction: For patients with BSI or avascular necrosis who were initially restricted from high-impact activities, these activities are gradually introduced in physical therapy once load tolerance improves.
• PT's Role in Function: The entire rehabilitation program is geared towards restoring the mechanics necessary for movement:

PT restores the required 60° to 65° of first MTP extension needed for normal ambulation, which is a prerequisite for high-impact activities.

Gait training is used to re-educate the hallux flexors on how to stabilise the first MTP joint during heel rise and function correctly under weight-bearing conditions.

What to Expect: Prognosis and Recovery Timeline for Sesamoiditis

The prognosis for sesamoiditis recovery is generally good with non-operative management, leading to high rates of return to activity, provided the patient adheres to load management and a comprehensive physical therapy (PT) plan.

Realistic Recovery Timeline (Weeks to Months)

The overall duration of recovery is highly dependent on the severity of the injury (simple sesamoiditis vs. bone stress injury or fracture) and whether the condition is acute or chronic at the time of intervention:

• Chronic Symptoms: Sesamoid pain is often chronic; patients seeking specialized treatment (like extracorporeal shockwave therapy and PT) often reported symptoms lasting a median of 18.5 months before intervention.
• Active Treatment and Return to Activity: Once specific non-operative treatment (including PT) is initiated, functional improvements are measurable within weeks:

One study focused on athletes found that functional gains were achieved over a median follow-up period of 11 weeks (ranging from 4 to 29 weeks).

Another pilot study involving radial shockwave treatment reported an average return to activity at 10 weeks.

A comprehensive physical therapy program alone showed significant improvement in function and pain reduction over just 12 treatment sessions distributed over 4 weeks.

• Severe Injuries: If the pathology includes a bone stress injury (BSI), recovery may require a longer timeline. Lower-grade stress fractures may resolve with three weeks of relative rest, while higher-grade fractures may require 16 or more weeks of activity modification.

Despite the potential for chronic pain, non-operative management has demonstrated good clinical results, with one systematic review noting an 86% return to activity rate following non-operative treatment.

Key Recovery Factors

Achieving successful recovery requires a coordinated approach centered on relieving stress on the forefoot and restoring normal biomechanics:

1. Load Management and Avoiding High-Impact Activity

Initial management involves rest, ice, compression, elevation, and activity modification to reduce symptoms and off-load the area.

• Activity Restriction: Load management is crucial, particularly because the sesamoid complex supports over 300% of body weight when pushing off in athletic activity.
• Differential Loading: Activity restrictions depend on the diagnosis. Patients with chronic sesamoiditis may be allowed to continue activities as tolerated, but those with evidence of bone stress injury (BSI) or avascular necrosis are advised specific activity restrictions or offloading during early treatment. This often means eliminating high-impact activities like running and may require non-weight bearing (using crutches) or protected weight bearing with a pneumatic boot during the initial phases.
• Gradual Introduction: High-impact activities must be gradually introduced in physical therapy after the initial restrictive phase.

1. Adherence to Rehabilitation (PT)

Adherence to physical therapy (PT) is paramount as it addresses the root causes of dysfunction, leading to lasting improvement:

• Restoring Functional Range of Motion (ROM): PT incorporates techniques like sesamoid mobilisations to overcome scarring and stiffness in the sesamoid complex that limits motion. Restoring the required 60° to 65° of first MTP extension is critical for normal ambulation and proper gait.
• Strengthening and Stabilisation: PT focuses on strengthening the intrinsic foot muscles and flexor hallucis muscles to stabilise the first MTP joint during heel rise and restore the foot core system.
• Gait Retraining: Once strength is restored, gait training is utilized to re-educate the muscles on how to function under weight-bearing conditions and ensure the normal joint axis and force distribution are restored, preventing recurring stress and pain.

Preventing Sesamoiditis: Tips for Long-Term Relief

Preventing the recurrence of sesamoiditis involves maintaining the strength, mobility, and proper biomechanics established during rehabilitation, especially since the condition is typically an overuse injury.

Maintain Foot Core Strength

• Intrinsic Muscle Strengthening: Long-term relief requires maintaining the strength of the intrinsic plantar foot muscles and the stabilization of the first ray, which are critical for gait mechanics and foot stability.
• Functional Exercises: Regularly performing exercises taught in PT, such as toe yoga (flexor hallucis brevis activation), toe spreads (abductor hallucis muscle strengthening), and foot doming (intrinsic arch muscles), helps the hallux flexors maintain their ability to stabilise the first MTP joint during heel rise during ambulation and athletic push-off.

Optimize Footwear and Offloading

• Custom Orthotics: Patients who benefited from orthotics or footwear modifications during rehabilitation should continue using them, especially for high-impact activities. For example, some patients were advised to continue wearing foot orthotics throughout and after treatment. Foot orthotics and rigid shoes are used to reduce motion and off-load the sesamoids.
• Appropriate Footwear: Ensuring that footwear is appropriate for activity helps prevent the repetitive overloading that leads to forefoot pain.

Address Biomechanical Risk Factors

• Addressing Abnormal Alignment: Sesamoiditis risk is associated with an abnormal supination movement system diagnosis (rigid foot, high arch) because this alignment can overload the sesamoids. Long-term prevention should involve continued adherence to exercises designed to mitigate the effects of this foot posture.
• Mobility Maintenance: Stiffness and loss of range of motion (ROM) in the first MTP joint shifts the axis of movement, making the joint susceptible to "jamming" and future injury. Regular performance of mobility exercises or manual therapy, if prescribed, should be used to maintain the necessary 60° to 65° of first MTP extension achieved during treatment.

Avoid Training Errors

• Gradual Load Progression: Sesamoid injuries are often linked to sudden increases in weight-bearing activities or training intensity. Athletes must adhere to a progressive training regimen, such as increasing intensity by only 10% per week when returning to full training after pain has resolved.
• Addressing Systemic Factors: Other factors that increase the risk of forefoot bone stress injury, such as poor diet, inadequate sleep patterns, and low bone density, should be addressed through athlete education.

Footwear and Orthotics: Choosing the Right Support

Footwear modifications and orthotic use are critical non-surgical strategies used in the initial management of sesamoiditis to off-load the sesamoids and reduce symptoms. The primary aim is to reduce the stress and weight-bearing forces transmitted through the first metatarsophalangeal (MTP) joint.

Key Offloading Strategies

• Foot Orthotics and Sesamoid Pads: Using foot orthotics, sesamoid pads, and footwear modifications can help reduce hallux dorsiflexion and physically off-load the sesamoids. Orthotics may incorporate specific features such as a cut-out for the sesamoids, metatarsal bars, a rigid shank, and/or a first metatarsal extension to decrease the load on the involved sesamoid and forefoot.
• Dancer's Pad: The use of a dancer's pad was a prior treatment utilized by several patients in the sources who experienced chronic sesamoid pain.
• Rigid Shoes: Clinicians may recommend using a rigid shoe to help limit motion and reduce stress on the forefoot.
• Taping: Taping of the sesamoids can help improve forefoot position and function, and may decrease shear forces on the sesamoids and the plantar aspect of the forefoot. If assessment reveals laterally displaced sesamoids, corrective sesamoid taping can be applied from the dorsomedial aspect of the forefoot to the plantar aspect to stabilise the bones.

Training Modifications to Reduce Overload

Since hallux sesamoid injuries are often associated with overuse or repetitive trauma, modifying athletic activity and addressing training errors are essential for recovery and preventing recurrence. The sesamoid complex supports over 300% of body weight when pushing off in athletic activity, meaning high-impact forces must be strictly managed.

Reducing Impact and Volume

• Activity Restriction and Offloading: Initial management requires activity modification. For patients with evidence of bone stress injury (BSI), avascular necrosis, or pain interfering with normal gait, specific activity restrictions or offloading during initial treatment are necessary. This often means patients are instructed to refrain from high-impact activities like running. In severe cases, offloading may involve non-weight bearing with crutches or protected weight bearing with a pneumatic boot.
• Progressive Volume Increases: Athletes are known to be at risk for bone stress fractures (which can occur in the sesamoids) due to a sudden increase in weight-bearing activities or training intensity. After being pain-free for 10–14 days, athletes can generally resume training with a 10% increase in intensity per week to allow for adequate tissue adaptation and remodelling.

Running and Movement Technique

The overall goal of physical therapy (PT) is to restore proper load distribution and toe-off mechanics to reduce forefoot loading.

• Restoring Functional Mechanics: PT includes gait training to reinforce the functional use of the hallux flexors. Patients are cued to "push your big toe down into the ground now and propel yourself forward" during terminal stance. This ensures that the muscles are re-educated on how to function under weight-bearing conditions, leading to proper force distribution and stabilization of the MTP joint during heel rise.
• Surface Type: Improper footwear or a change in running terrain may contribute to the overloading that leads to metatarsalgia and forefoot pain. Therefore, choosing appropriate, stable running surfaces in prevention and recovery.

FAQs About Sesamoiditis and Physiotherapy

"Can sesamoiditis become a stress fracture?"

Yes, sesamoiditis can be associated with or progress to a more serious bone stress injury. Sesamoiditis is a general clinical diagnosis referring to pain and inflammation associated with overuse. However, chronic hallux sesamoid pain may result from varied pathological conditions, including bone stress injury (BSI), fracture non-union, or avascular necrosis. In a retrospective case series of athletes with chronic sesamoid pain, 5 out of 11 patients had evidence of bone stress injuries on MRI evaluation. BSI is a microscopic bone injury resulting from repeated bouts of physiological overload without adequate time for remodelling.

"Is sesamoiditis serious?"

Sesamoiditis is serious because it is a debilitating source of pain that severely limits physical activity and athletic performance. Although non-operative treatment, including physical therapy, has demonstrated good clinical results with an 86% return to activity rate, the pain can be persistent and detrimental to athletes, limiting their ability to run and jump. If left untreated, chronic sesamoiditis may lead to scarring of the tendons, ligaments, and capsule, limiting motion and potentially progressing to functional hallux limitus (loss of motion). Furthermore, if the condition involves a bone stress injury or avascular necrosis, activity restriction or offloading (sometimes requiring crutches or a boot) is necessary during initial treatment. If non-operative management fails, surgical resection may be required.

"Should I walk with sesamoiditis?"

In most cases of uncomplicated sesamoiditis, walking and weight-bearing activities can continue as tolerated, but high-impact activities like running should be limited initially. For patients with clinical diagnoses of sesamoiditis (without clear evidence of a higher-risk injury), they were often allowed to continue activities as tolerated during treatment. However, the initial management always includes activity modification and offloading. If the pain is severe enough to interfere with normal gait, or if diagnostic imaging reveals a bone stress injury (BSI) or avascular necrosis, then you should restrict activity and may require offloading with crutches or a pneumatic boot. Even after pain decreases, successful long-term recovery requires gait training through physical therapy to ensure you are walking with proper mechanics and load distribution.

Beat Sesamoiditis – Book a Foot & Big Toe Assessment Today

Forefoot or big toe pain stopping you from running, jumping, or even walking comfortably? Whether you’re pushing off to sprint, dancing, or just standing at work all day, our physiotherapists can help you offload the sesamoids, restore big toe mobility, and rebuild foot strength so you can move confidently again.

Book Your Specialized Sesamoid Assessment Today:

• Phone: 905-669-1221
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Bibliography

Shamus, J., Shamus, E., Gugel, R. N., Brucker, B. S., & Skaruppa, C. (2004). The Effect of Sesamoid Mobilization, Flexor Hallucis Strengthening, and Gait Training on Reducing Pain and Restoring Function in Individuals With Hallux Limitus: A Clinical Trial. The Journal of Orthopaedic and Sports Physical Therapy, 34(7), 368–376. https://doi.org/10.2519/jospt.2004.34.7.368

Carroll, L. A., Paulseth, S., & Martin, R. L. (2022). Forefoot Injuries in Athletes: Integration of the Movement System. International Journal of Sports Physical Therapy, 17(1), 81–89. https://doi.org/10.26603/001c.30021

Schon JM, Gureck AE, Rhim HC, Malik GR, Tenforde AS. Treatment of chronic hallux sesamoid injuries with focused extracorporeal shockwave and physical therapy in an athletic population: a retrospective case series. Dtsch Z Sportmed. 2024; 75: 142-148. doi:10.5960/dzsm.2024.600

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