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1 · SNAPSHOT

Sesamoiditis body chart — Illustrative, not diagnostic. Canva body chart for Sesamoiditis.

Who: Runners, especially forefoot strikers, dancers, jumpers, and anyone in high heels. Common in young athletes.
What: Load intolerance of the sesamoid complex under the first metatarsal head — or one of six specific things that present identically.
How it behaves: Localised plantar pain under the ball of the great toe. "Bruised." Worse with running, jumping, push-off and high heels. Eased by offloading and a supportive, stiff-soled shoe.

The one thing to take from this page:

"Sesamoiditis" is a reasonable starting label and a poor finishing one. Persistent focal pain here has a differential you have to actually go and check.

What sits underneath the label

If it isn't settling, this is the list
Sesamoid stress fracture · fracture nonunion · avascular necrosis
Painful bipartite sesamoid · plantar plate / turf toe injury
Gout, inflammatory disease, or infection

Image when there is: persistent focal pain · night or rest pain · swelling · traumatic onset · failure to improve · a high-demand athlete or dancer.

⚠️ No guideline exists, anywhere. Anchored to a systematic review with pooled individual data [1] and a Delphi consensus [2] — which is structured expert opinion, not evidence, and is labelled that way.

2 · SE — THE SUBJECTIVE PATTERN (the 70%)

Five stages, in your course's order.

MAIN PROBLEM

"It's like I've got a bruise under my big toe."
"It's fine walking, it's the push-off that gets it."
"Every time I go back to running it comes back."

BODY CHART

Mark it plantar, under the first metatarsal head. Plantar is the diagnosis — dorsal is hallux rigidus, medial is hallux valgus.
Medial or lateral sesamoid? They are separate bones and separate problems.
Note any swelling or callus over the site.

BEHAVIOUR

	Fits sesamoiditis	Points elsewhere
Aggs	Push-off, running, jumping, high heels, barefoot on hard floors	Dorsal jamming on hills → hallux rigidus
Eases	Offloading, stiff-soled shoes, heel raise	Wide shoes → hallux valgus
Severity	VAS 0–10 at best / at worst / right now	—
Quality	Bruised, sharp on push-off	Acute pop with immediate loss of push-off → turf toe
Onset	Gradual — or post-traumatic	Acute hyperextension → turf toe

HISTORY

Load history. Running volume, surface, footwear change, forefoot strike, dance hours, a return after a break. This is usually the exposure.
Any single traumatic hyperextension event. If yes, this is a turf toe assessment, not a sesamoiditis one.
How many times has this recurred? Repeated failed returns is a reason to image, not to load more slowly again.

SPECIAL / SCREENING QUESTIONS

Night or rest pain — off the load-intolerance story.
Acute red, hot, swollen — gout or infection.
Bone health, energy availability, menstrual status where relevant — the stress fracture screen. Ask it in young athletes and dancers, who are the population this presents in.

Assessing this region? Download the Ankle & Foot assessment template →

3 · HYPOTHESIS RANKING

Competing pattern	The one discriminating feature
Turf toe	Acute hyperextension injury with plantar capsule tenderness and immediate loss of push-off. Sesamoiditis is gradual.
Hallux rigidus	Dorsal first MTP pain and stiffness with reduced dorsiflexion and a dorsal osteophyte. Sesamoid pain is plantar.
Gout	Sudden severe red, hot, swollen first MTP, often with nocturnal onset.

The list that matters more than the table

Sesamoiditis is a symptom label, and the imaging literature says so plainly — radiology should be looking for plantar plate or turf toe injury, fracture, infarct, arthritis and infection [3]. Add fracture nonunion (Artioli et al. 2025) and painful bipartite sesamoid (Nwawka et al. 2013).

The honest news: conservative care worked in less than half — 48.1% of sport-related medial sesamoid pain cases — and MRI in the non-responders found causes like bursitis, stress fracture or chondral lesions, but 42.8% of scans showed no specific abnormal findings [4]. So a conservative trial is right, and so is imaging the person it fails.

4 · RED FLAGS — DON'T MISS THIS

This section is free, on every pattern, forever. Safety is never gated.

Finding	What it suggests	What you do
Acute red, hot, swollen 1st MTP	Gout, or septic arthritis	Same-day medical review. Do not load it
Fever, systemically unwell with a hot joint	Septic arthritis or infection	🚑 Emergency
Night or rest pain, not load-related	Bone stress, infection, tumour	Image, medical referral
Traumatic hyperextension onset with a pop	Turf toe, plantar plate rupture	Image, and see the turf toe page
Persistent focal pain despite well-dosed offloading	Stress fracture, nonunion, AVN	Image — MRI
Focal pain + a load spike in a young athlete or dancer	Bone stress injury	Offload and image. Screen energy availability
Diabetes or neuropathy with a plantar pressure lesion	Neuropathic ulcer risk	🚑 See the infection page
A deep ulcer under the sesamoid that probes to bone	Sesamoid osteomyelitis	Urgent medical referral — don't keep padding it. 15 of 18 in one series ended in excision, resection or amputation (Mauler et al. 2017) [21]

The rule: load-related plantar pain that responds to offloading is yours. Persistent, nocturnal, traumatic, hot or systemic is not.

Cross-links: Turf toe · Hallux rigidus · Metatarsalgia

Members

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Twelve slides on this pattern: what you'll hear, what to examine, what to do. Free with an account.

Guideline anchor

No guideline exists for sesamoiditis, in Australia or anywhere.

Anchored to the systematic review with pooled individual data on conservative care (Biz et al. 2025, PMID 40731844) and the Delphi content-validity recommendations for assessment and management (Stewart et al. 2024, PMID 38820171), which is the closest thing to a consensus statement this condition has.

PubMed Source

A Delphi consensus is expert opinion structured, not evidence, and it is labelled that way here. The conservative-care evidence is limited but clinically consistent. There is no Australian guidance and no guideline anywhere.

Members

The evidence summary is for members

Verified diagnostic accuracy, where the evidence stands and what it doesn't settle. Free with an account.

Sources · 20

Show

Every source on this page resolves and title-verifies against PubMed. Newest first.

2025Biz et al. (2025). Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis. Medicina (Kaunas, Lithuania), 61(7). https://doi.org/10.3390/medicina61071215
2024Stewart et al. (2024). The development of recommendations for the assessment and management of sesamoiditis by podiatrists: A Delphi and content validity study. Journal of foot and ankle research, 17(2), e12025. https://doi.org/10.1002/jfa2.12025
2015Schein et al. (2015). Turf toe and sesamoiditis: what the radiologist needs to know. Clinical imaging, 39(3), 380-9. https://doi.org/10.1016/j.clinimag.2014.11.011
2024Choi et al. (2024). Atraumatic Sport-Related Medial Sesamoid Pain: Conservative Treatment Outcome and Magnetic Resonance Imaging Features. Clinics in orthopedic surgery, 16(4), 641-649. https://doi.org/10.4055/cios24037
2012Bichara et al. (2012). Sesamoidectomy for hallux sesamoid fractures. Foot & ankle international, 33(9), 704-6. https://doi.org/10.3113/FAI.2012.0704
2012Sharma et al. (2012). Utility of (99m)Tc-MDP SPECT-CT for the diagnosis of sesamoiditis as cause of metatarsalgia. Indian journal of nuclear medicine : IJNM : the official journal of the Society of Nuclear Medicine, India, 27(1), 45-7. https://doi.org/10.4103/0972-3919.108865
2013Nwawka et al. (2013). Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights into imaging, 4(5), 581-93. https://doi.org/10.1007/s13244-013-0277-1
2014Sims & Kurup (2014). Painful sesamoid of the great toe. World journal of orthopedics, 5(2), 146-50. https://doi.org/10.5312/wjo.v5.i2.146
2018Shimozono et al. (2018). Sesamoidectomy for Hallux Sesamoid Disorders: A Systematic Review. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 57(6), 1186-1190. https://doi.org/10.1053/j.jfas.2018.03.044
2020Hallinan et al. (2020). High-Resolution MRI of the First Metatarsophalangeal Joint: Gross Anatomy and Injury Characterization. Radiographics : a review publication of the Radiological Society of North America, Inc, 40(4), 1107-1124. https://doi.org/10.1148/rg.2020190145
2020Lombard et al. (2020). Hallux sesamoid complex imaging: a practical diagnostic approach. Skeletal radiology, 49(12), 1889-1901. https://doi.org/10.1007/s00256-020-03507-8
2020Dean et al. (2020). Functional Outcome of Sesamoid Excision in Athletes. The American journal of sports medicine, 48(14), 3603-3609. https://doi.org/10.1177/0363546520962518
2021Andrews et al. (2021). Diagnosis and conservative management of great toe pathologies: a review. Postgraduate medicine, 133(4), 409-420. https://doi.org/10.1080/00325481.2021.1895587
2022Sugimoto et al. (2022). Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 32(3), e276-e280. https://doi.org/10.1097/JSM.0000000000000902
2022Carroll et al. (2022). Forefoot Injuries in Athletes: Integration of the Movement System. International journal of sports physical therapy, 17(1), 81-89. https://doi.org/10.26603/001c.30021
2022Chen et al. (2022). High-Resolution Ultrasound of the Forefoot and Common Pathologies. Diagnostics (Basel, Switzerland), 12(7). https://doi.org/10.3390/diagnostics12071541
2023Kaur et al. (2023). The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand. Journal of foot and ankle research, 16(1), 29. https://doi.org/10.1186/s13047-023-00628-w
2023Lim & Liem (2023). First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations. Current sports medicine reports, 22(6), 217-223. https://doi.org/10.1249/JSR.0000000000001076
2025Artioli et al. (2025). Hallux Sesamoid Nonunion: A Comprehensive Systematic Review of Current Evidence. Journal of personalized medicine, 15(8). https://doi.org/10.3390/jpm15080342
2025Nakajima (2025). Avoiding Hallux Sesamoidectomy: A Narrative Review. Journal of clinical medicine, 14(21). https://doi.org/10.3390/jcm14217687

Mapped to this pattern

FFI
Foot Function Index
foot pain, disability and activity limitation · 23 items · 6 min

Generic measures that also apply

Related: turf toe · hallux rigidus · metatarsalgia

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