The sesamoids are two small bones under the big toe joint that help the foot push off. In active children and teenagers, repeated pressure through this area can cause pain known as sesamoiditis. This page explains sesamoid pain and how orthotic offloading and activity changes may help.
The sesamoid bones sit within the tendon under the big toe joint. They take a large amount of pressure during running, jumping, dancing and pushing off. Irritation of the sesamoids and surrounding tissues is called sesamoiditis.
Sesamoid pain is more common in teenagers involved in dance, gymnastics, sprinting, basketball and football. It may be more likely in children with high arches, which increase forefoot pressure, or in those wearing thin-soled or flexible footwear.
Because pain in this area can also be caused by a stress fracture, or by a sesamoid that naturally forms in two parts (bipartite sesamoid), assessment is important. Management typically centres on offloading the area with orthotic therapy, padding and footwear changes.
Children may not always describe symptoms clearly, so parents often notice changes in walking, activity or footwear first. Common signs include:
A podiatry assessment considers your child’s growth stage, symptoms, foot posture, walking pattern, activity levels and footwear.
Locates tenderness and assesses big toe joint movement.
Reviews arch height and forefoot loading.
Dance, sports, training and surfaces.
Checks sole thickness, stiffness and fit.
May be considered if a stress fracture is suspected.
Management is tailored to your child’s age, activity level, foot posture and goals.
Orthotic therapy is commonly used to offload the sesamoids. Orthoses or insoles may include a cut-out or ‘dancer’s pad’ that transfers pressure away from the big toe joint, along with cushioning materials and features that reduce big toe joint bending.
Offloading is usually combined with footwear that has a firmer, more cushioned sole and a temporary reduction in high-impact activities.
May reduce pressure on the sesamoids during activity.
Short-term reduction in jumping, sprinting or dance.
Cushioned shoes with a firmer sole.
Strapping to limit big toe movement may be discussed.
Foot and calf strengthening as symptoms settle.
A step-by-step plan back to full activity.
Learn more about orthotic therapy, strengthening, stretching and strapping, or view all treatments. Related kids conditions include high arches, foot fatigue in sport, hammer toes, overlapping toes, plantar warts.
Early offloading can help settle symptoms and reduce time away from sport or dance.
Please seek medical assessment if pain started after an injury, if there is significant swelling or bruising, or if pain persists despite rest, as imaging may be needed.
Repeated pressure under the big toe joint from running, jumping or dance is the most common cause, sometimes combined with high arches or thin-soled shoes.
Orthoses with a cut-out or padding can transfer pressure away from the sesamoids and reduce pain during activity.
Sometimes. If pain began suddenly, followed an injury or does not settle, imaging may be recommended.
It varies. With offloading and load management many children improve over several weeks, but recovery times differ.
We create a calm, supportive space to help children feel comfortable during assessment.
Where appropriate, prefabricated and custom foot orthoses are discussed based on assessment findings.
We help parents understand what is normal, what may need monitoring, and what can be supported.
Our clinic is located at 1/50 Kitchener Parade, Bankstown, and sees families from across Sydney, including Bankstown, Condell Park, Padstow, Revesby, Lakemba and Belmore. Visit our children’s podiatry page for more kids foot conditions, read about our clinic, or contact the clinic to make an appointment enquiry.
This information is general in nature and is not a substitute for individual assessment and advice. Outcomes vary between children. If you are concerned about your child’s health, please consult your GP or a registered health practitioner.
