Sesamoiditis physical therapy in Carmel, Indiana

The sesamoid bones are two small bones embedded in a tendon under the head of the first metatarsal, at the ball of the big toe. They act like pulleys for the tendon that bends the toe down and they absorb weight every time you push off, so repeated pressure on the ball of the foot can irritate them and the tissue around them.

Sesamoiditis tends to show up in runners, dancers who spend long hours on demi-pointe, baseball catchers, and court athletes who push off hard. High arches, a stiff big toe and thin-soled or high-heeled shoes all increase pressure on the area. A rapid jump in training, like ramping mileage for the Carmel Marathon in April, is a common trigger.

The pain sits under the big toe joint, unlike a Morton’s neuroma, which usually burns between the third and fourth toes, or a plantar plate injury under the second toe. Your therapist will press carefully to tell these apart.

Pads and shoes take pressure off the sesamoids so they can calm down, and loading exercises then restore the foot’s tolerance so the problem does not return the moment you go back to running. Both halves matter: offloading without rebuilding leaves a fragile foot, and loading without offloading keeps the area irritated.

A felt pad shaped like a donut or a J cut out under the big toe joint redistributes weight around the sesamoids. A shoe with a stiff sole or a rocker bottom limits how far the toe bends. AAOS OrthoInfo notes that if symptoms persist, a physician may recommend a removable walking brace for 4 to 6 weeks.

As pain settles, the therapist adds calf raises with the toe in a comfortable position, foot muscle work, big toe mobility and hip strength, then hopping and running drills. The suites have racks and dumbbells, so calf strength can be loaded meaningfully rather than only with bodyweight.

Gait changes can help too. Some runners do well with a slightly shorter stride and a slightly higher cadence, which softens the landing, while dancers may adjust how long they hold relevé in class for a few weeks. These are small, temporary tweaks rather than a complete overhaul of how you move.

• Felt donut or J-shaped pad cut out under the sesamoids
• Stiffer or rocker-sole shoes; lower heels for now
• Temporarily swapping running for cycling or swimming
• Calf and foot strength, then hopping and running drills
• Gradual return to dance, court sports or races

Today, stop the activities that press hardest on the ball of the foot: running, jumping, high heels, thin flats and barefoot work on hard floors. Swap in cycling with the pedal under the arch, swimming or upper-body training to stay fit while the area calms.

Wear a cushioned shoe with a stiff sole, and check the choosing running shoes after an injury guide before buying new pairs. Ice may ease soreness. Avoid stretching the big toe forcefully, and do not test it repeatedly by rising onto the toes.

If pain under the big toe has lasted more than a week or two, start the physical therapy questionnaire for foot pain. The matching team reads your answers and contacts you about a therapist in the network who works with runners and dancers. Dancers can also read physical therapy for dancers.