The symptom of Sesamoiditis is pain directly beneath the base of the big toe that gradually develops gradually into a dull ache and intensifies over time until it becomes an intense throbbing.

The sesamoid bones are two tiny bones located within the hallucis longus tendon, which is the flexor tendon that is attached to the big toe. These bones rotate forward and backward about two grooves in the first metatarsal head, acting as levers to increase the tension of the flexor tendon. Because of their location and function, the sesamoids are subject to intense pressure while walking or running. All direct pressure at this site is painful. Normal walking becomes so painful that gait is altered so that the heel and/or the outer margin of the foot bears the body’s weight. Over time, this can lead to a cascade of compensatory maladapted gait behaviors.

 Symptoms       Causes        Solutions

Dr. Sam Dubé discusses sesamoiditis

Learn about the symptoms, causes, and benefits of different treatment options.


 What causes sesamoiditis?


In addition to trauma, sesamoiditis commonly develops as a consequence of poor foot mechanics caused by footwear use.

Over time, poor foot mechanics become the maladapted functional norm, which predisposes the sesamoid bones to injury and damaging stresses. The sesamoids become situated so that they are subject to greater impact forces or the surrounding tendon is subject to excessive tension.

There are three primary causes that, individually or collectively, contribute to sesamoiditis-related maladaptive neuromuscular function:

  1. Inadequate firing of the flexor hallucis longus muscle

  2. Improper timing for firing of the flexor hallucis longus muscle

  3. Wearing restrictive footwear that inhibits the required raising of the great toe and corresponding raising of the arch system

Each can result in less-than-optimal sesamoid positioning—side to side, front to back, or both—contributing the excessive sesamoiditis related loading and tension forces.

Over time, stresses created by the excessive pressures lead to local tissue damage and inflammation around the sesamoid bones.

At rest, the sesamoid bones are usually positioned slightly behind the first metatarsal head. Ideally, while walking or running, the following takes place:

  • The sesamoids move forward, gliding in the groove around the first metatarsal head as the great toe rises

  • The great toe rises higher with increased activity levels, causing the sesamoids to rotate to a position in front of the first metatarsal head

  • The great toe rises before the foot contacts the ground in anticipation of the expected forces

In this forward position, the sesamoids are subjected to significantly lower impact and tension forces.

Modern science has identified that the nervous system plays a critical role in stabilizing the feet and ankles when walking or running. It is now understood that poor foot mechanics are a symptom of inefficient neuromuscular function caused by conventional footwear use. In fact, conventional footwear use causes poor neuromuscular function throughout the feet, legs, hips, and back, when:

  • the soles of the feet don’t receive the subtle, varied stimulus that the nervous system requires for healthy function, and

  • snug toe boxes, stiff midsoles/outsoles/uppers and tight lacing restrict healthy foot movement.

To learn more about the latest science, click HERE.



The best way to prevent and treat sesamoiditis is to retrain healthy neuromuscular mechanics and to use footwear that is soft, flexible, and roomier in the forefoot.

Conventional treatment methods for sesamoiditis

Since the late 1890s, the standard treatment for sesamoiditis related poor foot function has been to artificially support the foot with an orthotic. Other conventional sesamoiditis treatment options include:

  • Taping

  • Cushioning

  • Local tissue therapy

  • Injections

  • Surgery

Modern science has transitioned away from using long-term support and cushioning on any body part because it causes a progressive weakening of the body part being supported or cushioned.

The modern approach to treating sesamoiditis

Science has shown that merely challenging the body to “do its job” is the best way to restore and enhance function.

The modern approach to address poor neuromuscular function is to employ a “Proper Technique” rehabilitative therapy to regain healthy function. This approach is extensively used pre- and post-surgery and is also the foundation of virtually all sports training/rehabilitation programs. By employing a therapeutic approach, the feet become stronger and more stable, thereby addressing the cause of the poor foot mechanics that contribute to the sesamoiditis.

Proper Technique therapies employ exercise that focuses on safely training healthy neuromuscular function, i.e., optimal mobility, muscle strength, stability, and alignment.

Proper Technique therapies require both Right Stimulus and Right Movement.

Right Stimulus occurs when the information that the brain receives from the senses triggers an efficient protective reflex function or Right Movement. The nerve endings in the soles of the feet play a critical role in providing the brain with the information required for optimal Right Movement throughout the feet, legs, hips, and back. When the brain receives insufficient or inaccurate information from the soles of the feet, the protective reflex function Right Movement will be ineffective or absent altogether. This is what happens when conventional footwear is worn. For more information on Right Stimulus and Right Movement, click HERE.

To therapeutically address the cause of sesamoiditis and to prevent it from reoccurring, do the following:

  • Walk barefoot on natural terrain as much as possible. This provides the optimal Right Stimulus and allows for the Right Movement required for healthy neuromuscular function.

  • Use Biopods® Stimsoles® Footwear or Insoles. Biopods Footwear provides the ultimate Proper Technique shoe environment. Biopods Insoles improve the stimulus in your conventional footwear. Use in loosely laced, soft, flexible footwear with ample toe room that allows your arches and toes to rise easily for best results.

  • Consult with your healthcare practitioner to ask about employing soft tissue mobilization therapies to address the fibrotic scar tissue that may have formed prior to using Biopods.

For more information on what to expect when using Biopods, click HERE.

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