Login | June 14, 2026
Sesamoid?
PETE GLADDEN
Pete’s World
Published: October 4, 2021
One of the several perks of writing a column is that I can drone on and on about all my prior and current athletic overuse injuries.
So without further ado here's an obscure overuse injury I’ve been far too anxious to share with you––precisely because of it’s arcaneness.
I’m talking about an overuse injury involving the sesamoid bones of the foot. The “what-a-moid bones?”
Yeah, I’d never heard of them either until my sis, the doc, did a physical examination of my aching left foot two days after I finished a 12-day cycling trip to Vermont.
But before I go into my sesamoid dilemma, let me enlighten you as to the sesamoid’s form and function.
First of all, sesamoid bones are not exclusive to the foot, they occur in several joints of the body and they’re pretty small bones that are embedded in tendons.
Now with respect to the foot there are two of these tiny pea-shaped sesamoids and they’re located in the ball of the foot just beneath the big toe joint.
As far as function goes, the sesamoids kind of resemble pulleys for the big toe’s tendons, providing leverage when the big toe pushes off hard surfaces.
They also function as a weight-bearing platform for the first metatarsal bone––the long bone connected to the big toe. In this way the sesamoids provide a cushion against weight being placed on the ball of the foot.
Okay, now back to my sesamoid dilemma.
It’s that second function of the foot’s sesamoid bones––they’re cushioning function––where I ran into problems during my 12 days of six, seven and eight-hour-long cycling sessions.
What’s more, turns out that the linchpin of my sesamoid issue likely hinges on the fact that I have extremely high arches.
And folks like me with high arches are more susceptible to developing sesamoid problems.
So couple that genetic predisposition with my years of cycling multi-hour days wearing hard-soled carbon fiber cycling shoes (with minimal cushioning) and boom––a potential sesamoid issue at one or both of my big toes cropping up sometime in my cycling career was highly likely.
And well, it just so happened to crop up on this summer’s VT ride.
Now of the numerous overuse maladies that involve the foot’s sesamoid bones, my sister narrowed mine down to a malady termed “sesamoiditis,” an overuse injury involving chronic inflammation of the sesamoid bones and the adjoining tendons. And as is typically the case, this injury results from increased and/or constant pressure on the sesamoid bones.
And with respect to my exhibiting of sesamoiditis, that to was consistent with the injury––a dull, long standing pain beneath the big toe joint, where the pain comes and goes, usually displaying when certain shoes are worn and/or certain activities are undertaken.
For my sister, this diagnosis was darned near a no-brainer. So was my follow-up question: How do I get rid of it?
Well, there’s a host of nonsurgical treatments which include one or more of the following strategies.
The most obvious first step is ascertaining and then eliminating the activity causing the sesamoiditis.
Next is determining if that activity’s footwear is putting undo pressure on the sesamoid bones.
If footwear is indeed the culprit, then a more supportive shoe may be necessary. Orthotics with special paddings or cut-outs to accommodate the sesamoid bones can also solve the problem. In mild cases, such as mine, over-the-counter orthotic insoles could work in lieu of custom made orthotics.
All right, so after determining the offending activity/footwear side of this, the core rehab procedure for sesamoiditis consists of RIE - rest, ice and elevation.
In my situation I did the “R” and “E” portions of the rehab, and took a couple of weeks off cycling––the offending activity.
And as far as the footwear issue went, well, I took a wild guess and wondered if maybe the super-thin cycling socks I had strategically worn due to the hot weather might have been too thin and unsupportive during all those hours/miles of riding?
And guess what? Thicker cycling socks seemed to have solved the problem.Talk about a blind squirrel occasionally finding a nut.
Anyway, when it comes to overuse injuries, I like to think of myself as an athletic version of Jimmy Durante cuz ”I’ve had a million of um.”