Why Is there Pain Under My Big Toe?

Sesamoiditis at a Glance

• Condition: Sesamoiditis
• Location: Pain under the big toe joint and ball of the foot.
• Main symptoms: Localised pain, tenderness, swelling and pain during push-off.
• Commonly affects: Runners, dancers, athletes and active individuals.
• Main treatment approach: Load management, physiotherapy rehabilitation, footwear modification and progressive strengthening.
• Typical recovery: Often 6–12 weeks depending on severity and contributing factors.

Why Is There Pain Under My Big Toe?

Pain under the big toe is a common complaint, particularly among runners, dancers, gym-goers and active individuals. One possible cause is sesamoiditis, an overuse injury affecting the two small sesamoid bones located underneath the big toe joint.

Although these bones are small, they play a very important role in foot mechanics. The sesamoid bones help absorb load, protect the tendons around the big toe and provide leverage during walking, running and jumping. Every time you push off the ground, these small structures help transfer force through the foot.

When excessive stress is placed through this area, the sesamoid bones and surrounding tissues can become irritated and inflamed. This can lead to pain under the big toe, difficulty walking comfortably and reduced ability to participate in sport or exercise.

While sesamoiditis is a common cause of pain under the big toe, it is not the only possible explanation. Other conditions including arthritis, ligament injuries, tendon inflammation, joint irritation and stress fractures can create similar symptoms.

At BeFit Training Physio, we commonly assess active individuals experiencing pain under the big toe and the ball of the foot. Understanding the cause of your pain is the first step towards an effective treatment plan.

What Is Sesamoiditis?

Sesamoiditis is an inflammatory condition affecting the sesamoid bones and the tissues surrounding them underneath the big toe joint.

The foot contains two small sesamoid bones located within the tendons underneath the big toe. These bones act like pulleys, allowing the tendons to move efficiently while helping distribute forces across the forefoot during weight-bearing activities.

During activities such as running, jumping and sprinting, the sesamoid bones experience significant pressure. When this load exceeds the body’s ability to recover, irritation can develop.

Sesamoiditis is generally considered an overuse injury, meaning it usually develops gradually due to repeated stress rather than from one specific incident.

If symptoms are ignored, ongoing irritation can contribute to longer-term problems including chronic pain, reduced activity tolerance and, in some cases, stress reactions or fractures of the sesamoid bones.

What Causes Sesamoiditis?

There are several factors that can contribute to developing sesamoiditis. Often, it is not one single cause but a combination of increased load, biomechanics, footwear and activity demands.

Repetitive Stress and High-Impact Activities

Sesamoiditis is commonly seen in runners, dancers and athletes because of the repeated pressure placed through the ball of the foot.

Activities involving running, jumping, sprinting, rapid direction changes and repeated push-off movements increase stress through the sesamoid bones. Sports such as basketball, tennis, football and ballet can place particularly high demands on this area.

When the body does not have enough time to adapt to increased training loads, irritation and inflammation can occur.

Foot Structure and Biomechanics

Your foot shape and movement patterns can influence how pressure is distributed through the forefoot.

Individuals with high arches, a prominent first metatarsal head or certain alignment variations may place increased pressure beneath the big toe joint, increasing stress on the sesamoid bones.

Running technique, walking mechanics and lower limb strength can also influence how forces are transferred through the foot.

Improper Footwear

Footwear plays an important role in managing pressure beneath the big toe.

High heels can increase load through the forefoot by shifting body weight forwards. Shoes with thin soles, limited cushioning or a narrow toe box may also increase irritation around the sesamoid bones.

Choosing footwear appropriate for your activity and foot type can be an important part of managing and preventing symptoms.

Acute Trauma

Although sesamoiditis is usually an overuse injury, direct trauma can also contribute.

A hard impact, awkward landing or fall onto the ball of the foot can irritate the sesamoid bones and surrounding tissues. In some cases, trauma may contribute to bruising, ligament injury or a stress fracture.

Altered Foot Mechanics

Changes in foot mechanics, including excessive pronation (rolling in) or supination (rolling out), can alter how forces are distributed during movement.

This may increase stress through specific areas of the foot, including the sesamoid bones beneath the big toe.

Common Symptoms of Sesamoiditis

Recognising the symptoms of sesamoiditis early can help prevent the condition from becoming a longer-term problem.

The most common symptoms include:

• Pain underneath the big toe joint.
• Pain in the ball of the foot.
• Tenderness when pressing beneath the big toe.
• Pain when walking, running or standing for long periods.
• Pain during push-off movements.
• Swelling or inflammation around the big toe joint.
• Difficulty bending the big toe upwards.
• Pain during activities such as lunges, sprinting, jumping, sled pushes or planks where the toes are extended.

Many people notice symptoms are worse during activity and improve with rest. However, continuing to push through pain can increase irritation and delay recovery.

Who Is Most at Risk of Sesamoiditis?

While anyone can develop sesamoiditis, it is more commonly seen in people who place repeated stress through the front of the foot. This includes athletes, runners, dancers and individuals whose work or lifestyle involves prolonged standing or high-impact activity.

People who may be at increased risk include:

• Runners who regularly perform high mileage or increase training loads quickly.
• Dancers, particularly ballet dancers, due to repeated toe loading and pointing positions.
• Athletes involved in jumping, sprinting and rapid changes of direction.
• Gym participants who perform exercises involving loaded toe extension, lunges or sled pushes.
• Individuals who wear high heels, which increases pressure through the forefoot.
• People with specific foot mechanics, including high arches or altered movement patterns.

However, sesamoiditis is not limited to athletes. Anyone who suddenly increases their walking, running or exercise volume can overload the structures beneath the big toe and develop symptoms.

How Is Sesamoiditis Diagnosed?

Because pain under the big toe can have several different causes, an accurate diagnosis is important. A physiotherapist will assess your symptoms, activity history, movement patterns and the way your foot responds during different tasks.

Your assessment may include:

• Discussion about when your pain started and what activities aggravate it.
• Assessment of tenderness around the sesamoid bones.
• Checking big toe mobility and strength.
• Assessment of walking, running and lower limb mechanics.
• Functional testing such as single-leg balance, calf raises or sport-specific movements.

If your physiotherapist suspects a more significant injury, such as a stress fracture or another bone-related issue, imaging may be recommended. This may include an X-ray, MRI or other investigations depending on your symptoms and clinical findings.

Treatment for Sesamoiditis

The best treatment approach for sesamoiditis depends on the severity of your symptoms, your goals and the activities that are contributing to the problem.

The goal of treatment is not simply to reduce pain, but to identify why the sesamoid bones became overloaded in the first place and restore your ability to move confidently.

Load Management

One of the most important parts of recovering from sesamoiditis is managing the amount of stress placed through the foot.

This does not always mean stopping all activity. Instead, your physiotherapist can help modify your training, reduce aggravating movements and gradually rebuild tolerance through progressive loading.

This may involve temporarily reducing activities such as sprinting, jumping or high-impact exercise while maintaining other forms of training where appropriate.

Footwear and Activity Modification

Changing footwear can significantly reduce pressure beneath the big toe.

Your physiotherapist may recommend footwear modifications such as:

• Increasing cushioning under the forefoot.
• Avoiding shoes that compress the toes.
• Selecting footwear suitable for your activity.
• Using temporary offloading strategies if required.

Small changes to footwear and training habits can often make a significant difference in reducing irritation.

Physiotherapy Rehabilitation

Physiotherapy plays an important role in helping people recover from sesamoiditis and return to their normal activities.

A rehabilitation program may include:

• Reducing irritation and improving pain levels.
• Restoring big toe and foot mobility.
• Improving foot and ankle strength.
• Building calf and lower limb capacity.
• Addressing movement patterns contributing to overload.
• Gradually returning to running, sport or exercise.

The aim is to create a foot that is strong, adaptable and able to tolerate the demands placed upon it.

Physiotherapy Services at BeFit Training Physio

If you are experiencing pain under your big toe, the right assessment can help determine the cause and create a clear pathway back to activity.

Our physiotherapy team can help with assessment, diagnosis and rehabilitation through the following services:

General Physiotherapy

Our General Physiotherapy service focuses on identifying the cause of your pain, improving movement and developing a personalised treatment plan to help you recover.

This is suitable for individuals experiencing foot pain, joint pain, soft tissue injuries or movement-related problems affecting daily life.

Sports Physiotherapy

For runners, athletes and active individuals, our Sports Physiotherapy service provides targeted assessment and rehabilitation to help you safely return to training and competition.

Sports physiotherapy focuses on understanding the demands of your activity and creating a plan that restores strength, confidence and performance.

Performance Physiotherapy

If your goal is returning to high-level sport, improving performance or preventing future injury, our Performance Physiotherapy service provides a more advanced approach to rehabilitation and return-to-sport planning.

This approach focuses on building capacity, improving movement efficiency and ensuring your body is prepared for the demands of your sport.

Can You Exercise With Sesamoiditis?

In most cases, complete rest is not required. The key is identifying which activities are aggravating your symptoms and modifying them appropriately.

Low-impact activities that do not increase pain may often be continued while the foot recovers. Your physiotherapist can guide you on when and how to safely reintroduce higher-impact activities such as running, jumping and sport.

A gradual return to activity is important because returning too quickly can cause symptoms to flare up again.

How Long Does Sesamoiditis Take to Heal?

Recovery time varies depending on the severity of the condition, how long symptoms have been present and how well contributing factors are addressed.

Mild cases may improve within several weeks, while more persistent cases can take several months to fully settle. A structured rehabilitation plan can help improve recovery outcomes and reduce the chance of recurrence.

When Should You See a Physiotherapist for Big Toe Pain?

If pain under your big toe is affecting your ability to walk, run, train or participate in sport, it is worth getting assessed early.

While some cases of sesamoiditis may settle with simple modifications, persistent pain should not be ignored. Continuing to load an irritated sesamoid bone without addressing the underlying cause may increase the risk of chronic symptoms, stress reactions or more significant injury.

You should consider seeing a physiotherapist if:

• Your pain has continued for more than a few days despite reducing activity.
• You experience pain when walking or pushing off your big toe.
• You cannot run, jump or train without symptoms.
• You notice swelling, bruising or significant tenderness beneath the big toe.
• Your symptoms are progressively worsening.

Book Your Sesamoiditis Assessment at BeFit Training Physio

Pain under the big toe can be frustrating, especially when it prevents you from doing the activities you enjoy. The good news is that with the right diagnosis, load management and rehabilitation plan, most people can return to normal activity.

At BeFit Training Physio, our physiotherapists will assess your symptoms, identify the factors contributing to your pain and develop a personalised treatment plan designed around your goals.

Whether your goal is returning to running, getting back to sport or simply walking without pain, our team can help guide you through the recovery process.

Book an assessment today and take the first step towards understanding and managing your big toe pain.

Related Reading

If you are experiencing pain around your big toe but are unsure of the cause, our related guide explores other common causes, symptoms and treatment options:

Big Toe Pain: Common Causes, Symptoms and Treatment

Frequently Asked Questions About Sesamoiditis

What causes pain under the big toe?

Pain under the big toe can be caused by several conditions, including sesamoiditis, stress fractures, arthritis, tendon irritation, ligament injuries and joint inflammation. A proper assessment is important to determine the exact cause.

What is the fastest way to heal sesamoiditis?

The fastest way to improve sesamoiditis is to identify and reduce the factors causing excessive stress on the sesamoid bones. This may include modifying activity, improving footwear, managing training loads and following a progressive rehabilitation program with a physiotherapist.

Can running cause sesamoiditis?

Yes. Running is one of the most common activities associated with sesamoiditis because the sesamoid bones experience repeated loading during the push-off phase of each stride. Sudden increases in running volume, speed or intensity can increase the risk of irritation.

Can I still walk with sesamoiditis?

Many people can continue walking with sesamoiditis, although walking may become uncomfortable. If walking consistently increases pain, it may be a sign that the area needs better load management and assessment.

Does sesamoiditis require surgery?

Surgery is rarely required for sesamoiditis. Most people improve with conservative treatment including physiotherapy, activity modification and rehabilitation. Surgery is generally only considered in specific cases where symptoms do not improve with appropriate management.

Can orthotics help sesamoiditis?

In some cases, orthotics or temporary offloading devices may help reduce pressure beneath the big toe. Whether they are beneficial depends on your foot mechanics, symptoms and the underlying cause of your condition.

How do you know if you have a sesamoid fracture?

A sesamoid fracture may cause pain beneath the big toe, swelling, bruising and difficulty loading the foot. Because symptoms can overlap with sesamoiditis, imaging such as X-ray or MRI may be required to confirm the diagnosis.

When should I get my big toe pain checked?

You should consider an assessment if your pain is persistent, affects your ability to exercise, changes your walking pattern or does not improve with simple activity modification.

References

This article is based on current clinical understanding of foot biomechanics, sports injury rehabilitation and musculoskeletal physiotherapy principles.

1. American Academy of Orthopaedic Surgeons (AAOS).
   Sesamoid Injuries of the Foot.
2. American College of Foot and Ankle Surgeons.
   Foot and Ankle Conditions Information.
3. FootCareMD – American Orthopaedic Foot & Ankle Society.
   Sesamoid Injuries and Foot Conditions.
4. Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine. McGraw-Hill Education.
5. Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. Elsevier.

Summary

Sesamoiditis is a common cause of pain under the big toe, particularly in runners, dancers and active individuals. The condition occurs when the small sesamoid bones beneath the big toe become irritated due to repeated stress or overload.

Early diagnosis, appropriate load management and a structured rehabilitation program can help reduce symptoms and restore your ability to walk, run and participate in sport.

If you are experiencing ongoing pain under your big toe, the team at BeFit Training Physio can help assess the cause and guide you through your recovery.