Sesamoid Injuries Explained

Our expert podiatrists know a thing or two when it comes to feet related injuries. Resident Sports & Spinal podiatrist, Dylan McDonald has helped define  sesamoid injuries, how they occur, the risk factors involved and the available treatment options.

Sesamoids, What are They?

The 1st metatarsophalangeal (MP) joint in the forefoot consists of 4 bones;

The proximal phalanx of the hallux,

The 1st metatarsal and,

Two sesamoid bones.


Sesamoid bones play an important role in the function of the big toe. Similarly, like that of the patella in the knee. Located within the flexor hallucis brevis tendons, the sesamoids:

  • Functionally lengthen the 1st metatarsal
  • Protect the flexor hallucis longus tendon
  • Assist in weight transfer from the lateral to medial aspect of the forefoot

Risk Factors & Symptoms

Injuries to the sesamoids may be caused by landing after a jump, sprinting or dancing (activities that increased forefoot pressure) or following traumatic dorsiflexion of the big toe.

Symptoms often present as localised pain to the plantar 1st MP joint with weight-bearing through the forefoot, worse with sports involving higher forefoot loading and change of direction (i.e. basketball or tennis) or stair climbing.

The athlete may attempt to avoid painful toe-off through the 1st MP joint by an altered walking pattern. Examination of the foot reveals pain and tenderness of one or both of the sesamoids, often accompanied by swelling, warmth and redness. Moving the 1st MP joint against resistance is often painful, restricted and/or weak.

The larger, medial sesamoid (77%) is more frequently injured compared to the lateral sesamoid (23%), due to the comparatively increased weight-bearing forces it becomes exposed to.

Forefoot pronation and progressive hallux valgus can contribute to this presentation and can influence the smooth gliding of the sesamoid bones beneath the 1st MP joint.

Other Risk Factors Include:

  • Repetitive trauma
  • Mechanical overload with pes cavus foot type
  • Significant plantarflexed 1st ray
  • Ankle equinus5

In conjunction with physical examination, further radiology investigation is required to examine and diagnose the precise pathology that presents with sesamoid pain. X-Rays with a special view of the sesamoids is frequently used first, following by an MRI or Bone Scan.

Treatment Options

A goal of treatment is to reduce direct pressure to the sesamoid bones, allowing time and capacity to heal. Load and physical activity changes, icing and pain-relief & anti-inflammatory medication is used initially to manage pain, in addition to accommodative padding within footwear.

Foot orthoses, with this prescribed feature, can address the biomechanics and reduce load where needed. A gradual return to full-weight bearing and sporting activity can be achieved with footwear changes (stiff-soled or curve forefoot sections), re-introducing controlled loading through the 1st MP joint.


Written By Podiatrist, Dylan McDonald

Dylan graduated from the Queensland University of Technology as a Podiatrist, following earlier studies in Exercise and Nutrition Science (Hons.) at the University of Queensland. He continually expands on his knowledge and skills to keep up-to-date with the developing science behind lower limb conditions and injuries.

Whilst Dylan has a special interest in sports and biomechanical podiatry (including paediatric patients), he has experience treating all aspects of general lower limb and foot care. Dylan utilises biomechanical assessments, gait/movement analysis, orthotic therapy, footwear assessment and recommendations, dry needling and general/diabetic screenings to get the best outcomes for his clients. He has a unique skillset in foot mobilisation and manipulation which has formed part of his continuing clinical expertise.

He has a unique skillset in foot mobilisation and manipulation which has formed part of his continuing clinical expertise.

Dylan has been involved in numerous sports as a junior athlete, particularly in AFL where he has previously held roles as a strength and conditioning coach and sports trainer (current) with the Queensland Junior Talent programs. In his spare time, Dylan enjoys travelling, live music and working on his handicap out on the golf course.

Dylan is available for Podiatry appointments at our St LuciaWoolloongabba and Springfield locations.