Monthly Archives: January 2012

I have had several runners and one roller derby player come to the office recently having sesamoiditis. The sesamoids are two small bones which are embedded in the tendon directly underneath the big toe joint. They act as a stabilizer of the big toe, keeping the toe moving up and down as opposed to side to side.

Sesamoids can occasionally fracture or be bipartate. Bipartate means that an individual sesamoid which normally starts out as two pieces and fuses together doesn’t fuse, leaving the two pieces separate, which the image below shows.

High-arched feet have a greater tendency to develop sesamoiditis than flat feet. Excessively worn, poor fitting or improperly designed shoes can also cause sesamoiditis.

Medical treatment depends on the severity of pain include icing, anti-inflammatory medications (Advil/Aleve), cortisone injections into the joint, immobilization and orthotics.

Shoe treatments include wearing a shoe that doesn’t flex at the forefoot or have a thin, non-shock absorptive sole. In a running shoe, this means no flex groove directly under the big toe joint where the sesamoid is inflammed.

Going barefoot is also not a good idea until the area heals.

Since the sesamoids bear weight with every step, this condition can take several weeks to months to improve. If however, the pain remains unchanged in spite of the treatment, then MRI should be used to make sure there’s no fracture. Fractured sesamoids require non-weight bearing immobilization with cast and crutches and occasionally surgical removal of the sesamoid.

If you have pain under the big toe joint that doesn’t improve with reduced activity and rest then you may have a fracture. Whether or not you have big toe discomfort of pain, it’s important to see a podiatrist for evaluation. Waiting to seek treatment can make this condition worse.

Horizontal grooves in the forefoot of running shoe outsoles are called flex grooves. As the name implies, flex grooves are designed to promote forefoot flexion across the ball of the foot.

In many cases of forefoot pain, however, this is exactly where you don’t want the shoe to bend. You actually want the shoe to be as inflexible as possible in this area if you have the following forefoot conditions: hallux limitus, sesamoiditis and metatarsalgia.

If you have forefoot pain, deep flex grooves located directly beneath the affected joint will cause an increase in forefoot flexion as well as reduced shock absorption due to a lack of an overlying outsole in the area of a groove.

The shoe on the left side of the image has flex grooves adjacent to where the forefoot bends, which can alleviate forefoot pain. The shoe on the right side of the image has a flex groove where the forefoot bends, leading to more pressure in this area.

If you experience pain in the forefoot, check the flex groove placement in your shoes. Flex grooves in the wrong place can contribute to forefoot pain.