Forefoot Pain for Runners (Sesamoiditis)

Runners heading out for spring and summer training should be aware of a common forefoot ailment called sesamoiditis, which causes pain in the ball of the foot. According to Dr. Suzanne Belyea, medical director of Foot.com, the term sesamoiditis describes any irritation of the sesamoids, tiny bones located within the tendons attached to the big toe. “The sesamoids function as a pulley, like the kneecap, increasing the leverage of the tendons controlling the toe. Every time you push off against the toe, the sesamoids are involved, and with heavy activity they can eventually become irritated, even fractured” Dr. Belyea says. Sesamoiditis is a form of tendonitis because the tendons around the bones also become inflamed.

The most common symptom of this condition is pain in the ball of the foot, especially on the medial, or inner, side. Sesamoiditis can typically be distinguished from other forefoot conditions by its gradual onset. Pain usually begins as a mild ache and increases gradually as the aggravating activity, such as running, is continued. “The pain can build up to an intense throbbing” Dr. Belyea says. “In most cases, though, there is little or no bruising or redness”.

Increased activity is one of the major causes of sesamoiditis. For runners and other athletes, speed work, hill work, or even increased mileage can cause the problem. People with bony feet or with high arches tend to be more susceptible because of the added pressure on the forefoot. Minor cases of sesamoiditis call for a strict period of rest, along with the use of a modified shoe or a shoe pad to reduce pressure on the affected area. A metatarsal pad placed away from the joint can redistribute weight-bearing pressure to other parts of the forefoot. The big toe can also be bound with tape or athletic strapping to immobilize the joint as much as possible and allow for healing to occur. Decreasing or stopping activity for a while will give sesamoids time to heal. If the patient does continue to work out, Dr. Belyea recommends applying ice to the area for 10 to 15 minutes after exercise, or after any activity that aggravates the area. As with icing, anti-inflammatory drugs will help decrease swelling so healing can begin. Women should wear flat shoes while the injury is healing.

It's always a good idea to see a doctor for a correct diagnosis, especially if home remedies do not work.

Credits

Run The Planet thanks Foot.com—the “Foot Health Network“ dedicated to educating the public about foot health, pain and products—for the permission to reprint the article “Runners' forefoot pain might be Sesamoiditis”. Text and illustration copyright © 2003 by Foot.com.