Under the big-toe joint sit two small bones, the sesamoids, like tiny kneecaps for the toe. They take the entire push-off of walking, dancing, and a stiletto. When they inflame (or crack) every step onto the ball of the foot feels personal. Sesamoiditis is one of the reasons high-heel patients and dancers find Dr. Levine.
Sesamoiditis is inflammation of the sesamoid bones or the tendons that attach to them. A sesamoid can also fracture (see stress fractures) or develop arthritis. The pain is under the first metatarsal head (the ball of the foot on the big-toe side) and is easy to mislabel as a neuroma or generic metatarsalgia.
We press each sesamoid, watch toe-off, and X-ray. Sesamoids can be bipartite (in two pieces from birth); that is not automatically a fracture. If the film is quiet and the bone is exquisitely tender, we treat it as a stressed sesamoid and image further when it does not follow the expected curve.
A dancer’s pad, a cutout under the first metatarsal, a stiff-soled shoe, and sometimes a boot. The bone needs a vacation from push-off.
Custom devices that shift load off the sesamoids are the long-term answer for a foot that is built to overload them.
When the fat pad is gone, Pillows For Your Feet® put something between bone and sidewalk again.
Used sparingly. A sesamoid that is fractured or badly arthritic will not be talked out of it with cortisone. Stem cell options are for selected chronic cases.
Partial or complete sesamoid removal is a last resort because it changes big-toe mechanics. Your podiatrist will say so if we are even having the conversation.
Expect weeks of modified push-off. Dancers and runners return in stages. Heels return when the bone is quiet and the cushion is in place; not as a test of willpower.
Evaluation typically $150–$400. Padding, orthotics, fillers, and regenerative injections are quoted after imaging. Surgery, rare, is separate.
Neuromas live between the third and fourth toes more often than under the first. Location matters.
Usually, after a period of offloading and a return that does not start at full rehearsal volume.
Almost never as plan A.