The Back Pain Doctor
Sesamoiditis is pain in the ball of the foot at the base of the big toe, caused by irritation of the tendons around the two small sesamoid bones that sit under the big toe joint. It is a form of tendinitis and is common in dancers, runners and other activities that repeatedly load the forefoot. The same bones can also fracture — either suddenly, when the big toe is forced sharply backward, or gradually as a stress fracture.
Assessment focuses on localising the tenderness to the sesamoids, checking big-toe movement, and using a weight-bearing forefoot X-ray when a fracture is suspected. A naturally two-part sesamoid can mimic a fracture, so imaging is interpreted with care; a bone scan or MRI is reserved for cases that remain unclear or do not settle with first-line care.
First-line care is usually conservative — resting from the aggravating activity, ice and simple analgesia, supportive footwear, and cushioning pads or orthotics to offload the sesamoids, often coordinated with a podiatrist or physiotherapist. A fracture may need a stiff-soled shoe or short walking brace and can take several months to settle. Most sesamoid problems resolve without surgery, which is reserved for persistent symptoms or a displaced or non-healing fracture.
The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.
This is the starting point for most musculoskeletal conditions.
The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.
Evidence is condition-specific; it is not a universal pain treatment.
Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.
Read moreEvidence varies substantially by condition, tissue and preparation method.
PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.
Read moreBest used for specific inflammatory or irritable pain generators, usually for short-term relief.
An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.
Read moreClinical evidence is still developing and guideline support is limited.
EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.
Read moreEvidence is condition-specific and generally less established than exercise-based care.
Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.
Read moreMost relevant when focal myofascial pain is a clear contributor.
Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.
Read moreRelevant only when the history and examination support nerve irritation or entrapment.
Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.
Read moreThis is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
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Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
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