Sesamoiditis: The Injury That Can Cause You to Wear Heels Too Much

The Fast Facts

• Sesamoiditis consists of inflammation of the sesamoid bones of the foot (they are the small, rounded bones of the joints that have a tendon embedded) that are located on the sole, specifically in the head of the first metatarsal.
• The lack of fat in the plantar pad since this pad is like a natural cushioning of our body; If we have too little, the impact is greater and this causes inflammation and pain.
• Not wearing high heels, softening the loading of the front-foot, doing the forefoot with good cushioning from the shoe, and insoles that take the load off the sesamoids are all helpful.

Sesamoiditis consists of inflammation of the sesamoid bones of the foot (they are the small, rounded bones of the joints that have a tendon embedded) that are located on the sole, specifically in the head of the first metatarsal.

Sesamoiditis: The Injury That Can Cause You to Wear Heels Too Much.

It is one of the most common pathologies in runners according to the Illustrious College of Podiatrists of the Valencian Community (ICOPCV).

Abusing excessively high-heeled shoes is one of the main causes of this injury as it produces hyperpressure on the sesamoid bones.

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Other causes could be:

• The lack of fat in the plantar pad since this pad is like a natural cushioning of our body; If we have too little, the impact is greater and this causes inflammation and pain.
• Having cavus feet, people who have cavus feet, with a lot of curvature in the plantar arch, continually generate hyperpressure in the area.

Treatments for Sesamoiditis.

The treatments for this ailment are very varied depending on its severity.

Milder cases can be treated by simply stopping the activity that causes it, applying cold to the sesamoid bones, wearing shoes with padding in the front, using personalized insoles or taking analgesia.

In more complex conditions, infiltration of hyaluronic acid in the area may be necessary. And, in severe cases, it may require removal of the affected bones.

What Do Research Says about Sesamoiditis?

A systematic review, which is named the Conservative Treatment of Sesamoiditis (2025), highlights the fact that there are limited guidelines but conservative treatment may be effective. In the 2024 trial of atruamatic medial sesamoid pain (in sports-active adults) close to 48 per cent of patients were helped using a conservative treatment plan (activity restriction, insoles, NSAIDs, boot walker). However, that too does not solve over half and calls into additional consideration (MRI-detected intraosseous changes, chondral lesions). ^(1),(2)

Expert Opinion From Podiatrists / Foot & Ankle Specialists.

​‍​‌‍​‍‌​‍In a recent focus-group study conducted in Aotearoa New Zealand, podiatrists were found to emphasize a biomechanical approach: patient history, symptom recreation, identification of contributing foot posture/arch/habit factors, and elimination of other diagnoses. As per Daniel Bohl (foot & ankle surgeon), most situations are handled by non-surgical methods, however, the surgical removal of one diseased sesamoid bone (sesamoidectomy) can be very efficient if the accompanying soft-tissue repair is done with care.

Key Takeaways from Experts.

• Footwear is a major factor: Not wearing high heels, softening the loading of the front-foot, doing the forefoot with good cushioning from the shoe, and insoles that take the load off the sesamoids are all helpful.
• Body mechanics are the core: Having high arches, being forefoot-dominant during weightbearing, or having weak fat pads can increase the risk and may prolong the recovery process.
• Conservative treatment first, immediate surgery later: The majority of cases are handled without surgery — it is only a last resort when conservative treatment fails.
• Personalized treatment: Since there are numerous factors contributing (foot shape, activity levels, shoe habits, load/impact), the treatment has to be ​‍​‌‍​‍‌​‍​‌‍​‍‌individualized.

Frequently Asked Questions.

Bottom Line.

Sesamoiditis can be a minor foot issue that a person can overlook, but the lack of support or the use of high heels and tight shoes can transform the nuance of the inflammation into the chronic pains. The secrets of fast recovery and healthy feet are early rest, footwear, and professional advice.

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