Ball Of Big Toe Pain / Seesamoiditis

[DayTrip]

I'll preface my question with the usual disclaimer that I realize any advice here is for guidance only and shouldn't replace the advice of a doctor or physician. However, my current issue is deemed "non essential" right now by doctors (my current one at least) and that is not an option for awhile.

So for years I've had inflammation/swelling on the "ball" of the big toe on my left foot. Never really bothered me at all hiking or in regular life wearing shoes but would be mildly uncomfortable sometimes bare foot. A few weeks ago as everything started shutting down and as my activity level plummeted the pain has escalated quite a bit. Walking and hiking is very uncomfortable even in my favorite shoes. I did a little research and apparently what I have is sesamoiditis (at least the description of this is pretty much exactly what I am experiencing), which is a common repetitive use injury/condition caused by inflammation around two tiny bones that float inside the mass of tendons under the big toe.

Doesn't look like there is much that can be done with this. Consensus is to ice it often, elevate, take ibuprofen to reduce swelling and reduce activity. Also looks like there are orthotics out there that can help. If none of this works I guess a cortisone shot can be given and eventually if nothing works surgery is an option, which I'd like to avoid obviously. On my last hike I taped a "spacer" in between my big toe and 2nd toe and then taped them both together and that seemed to help quite a bit so I'm hopeful this is a manageable situation.

So, is anyone else out there experiencing this sort of issue and if so what types of things have you been doing to manage the situation? With the current circumstances I've been able to do the ice/elevate/stretch thing more often but I'm seeing very little result. I find heat helps more but that should in theory at least not be a good idea for inflammation but it seems to loosen it up a bit. I guess I'm hoping to find some sort of off-the-shelf orthotic that I can actually obtain right now for help because taping every day is tedious and will get expensive buying athletic tape so often. Any ideas on the topic would be appreciated. Thanks in advance.

 

[TCD]

For various inflammation from acute injuries in extremities, I have had good results with "contrast baths."

Rather than just a long ice session, or a long heat session, you go back and forth a few times. Ice the area until it becomes achy and uncomfortably cold. Then switch into the warm (typically 102F) water bath, and keep it moving. When the warm becomes uncomfortable, back into the ice. Perhaps 3 or 4 cycle back and forth. With a small part like a toe each cycle only takes a couple minutes. (Bigger areas like a knee take longer to heat up and cool down.)

I first learned this technique from my (Physical Therapist Assistant) wife when I popped a finger pulley several years ago climbing. The contrast baths worked wonders to get the swelling and inflammation out of the finger.

 

[DayTrip]

For various inflammation from acute injuries in extremities, I have had good results with "contrast baths."

Rather than just a long ice session, or a long heat session, you go back and forth a few times. Ice the area until it becomes achy and uncomfortably cold. Then switch into the warm (typically 102F) water bath, and keep it moving. When the warm becomes uncomfortable, back into the ice. Perhaps 3 or 4 cycle back and forth. With a small part like a toe each cycle only takes a couple minutes. (Bigger areas like a knee take longer to heat up and cool down.)

I first learned this technique from my (Physical Therapist Assistant) wife when I popped a finger pulley several years ago climbing. The contrast baths worked wonders to get the swelling and inflammation out of the finger.

Excellent. I'll give that a try. Thanks.

 

[JustJoe]

i looked up Seesamoiditis, and as I'm sure you read, first thing to do is stop the activity causing the issue. Daa! Of course I've never been one of those. But, I've had meniscus tears (once needing surgery) plantar fasciitis, post broken ankle issues. All of those first step was PT. Don't see that mentioned for Seesamoiditis. Plus what you have mentioned, RICE. Rest, ice, compression, elevation. But in all instances, what was also prescribed was Aleve (or eequivalent). But, double the dosage. 2 very 12 hours instead of 1. But for no longer than 14 consecutive days. Anyway, good-luck.

 

[DayTrip]

i looked up Seesamoiditis, and as I'm sure you read, first thing to do is stop the activity causing the issue. Daa! Of course I've never been one of those. But, I've had meniscus tears (once needing surgery) plantar fasciitis, post broken ankle issues. All of those first step was PT. Don't see that mentioned for Seesamoiditis. Plus what you have mentioned, RICE. Rest, ice, compression, elevation. But in all instances, what was also prescribed was Aleve (or eequivalent). But, double the dosage. 2 very 12 hours instead of 1. But for no longer than 14 consecutive days. Anyway, good-luck.

I didn't see PT directly in articles I read but came across several types of stretches to try so I guess that is the same thing. They work to a point I guess but not really game changing. And of course I realize stopping the activity is important. What's been weird though is that stopping the activity is what caused the pain to escalate too much. So I'm thinking/hoping that I just got stiff and loosening it up again will resolve to a point. Between this and corona I think I can cross a thru hike off my goals for the year - again.

 

[Mike P.]

Have you seen a MD before about it. My Son has suffered from stress fractures related to running which is his passion. Upon going to the MD, the doctor saw that his 2nd toe is longer than his big toe. He used to wear & run in Nike exclusively. Because of the structure of his foot, Nike were the worse brand he could wear. Dr. recommended brands that were not leaning forward (not the technical term) and either neutral or with a higher front. His feet need as much cushioning as mine, mine due to weight & his due to his feet.

His second toe, due to it's length, will take more of the repetitive stress than the toe can handle. While different, your feet are telling you they are unhappy.

If you haven't yet, find a good orthopedist when you can & bring what you are wearing. Your foot structure may be such that what you like to wear may not be good to wear.

 

[DayTrip]

Have you seen a MD before about it. My Son has suffered from stress fractures related to running which is his passion. Upon going to the MD, the doctor saw that his 2nd toe is longer than his big toe. He used to wear & run in Nike exclusively. Because of the structure of his foot, Nike were the worse brand he could wear. Dr. recommended brands that were not leaning forward (not the technical term) and either neutral or with a higher front. His feet need as much cushioning as mine, mine due to weight & his due to his feet.

His second toe, due to it's length, will take more of the repetitive stress than the toe can handle. While different, your feet are telling you they are unhappy.

If you haven't yet, find a good orthopedist when you can & bring what you are wearing. Your foot structure may be such that what you like to wear may not be good to wear.

I was going to consult an MD but I can't right now because it is not considered essential. It wouldn't shock me if I had other underlying issues with my feet/legs. I have walked on the outside edges of my feet my entire life and I'm somewhat "bow legged" in that my feet usually point slightly outward (more my right than my left). My left foot is also my larger foot and historically is the one that pays the price when I buy shoes that aren't quite the right fit.

There really isn't anything new about the shoes or volume of hiking I have done in say past year or so. The only change was the sudden drop off in activity at work and hiking when the whole corona thing kicked off. I have tried "zero drop" shoes with wide toe boxes like the Altras and they are really comfortable but I found them to not be nearly durable enough for hiking. I was having all kinds of issues with wear and holes after only about 50 miles of White Mountain hiking.

 

[Grey J]

I've got a really bad big toe as well on my left foot. It looks kind of like a bunion but it's actually the result of me dropping a very heavy trailer hitch on it working construction back in 1973. I broke the toe and it didn't heal properly because I just limped around and worked through it because I needed to keep the job. It took decades for it to get this bad but it is malformed and arthritic and has eventually even changed the contour of the arch on that foot. Sometimes it hurts like hell and other times I forget about it and play league tennis and climb mountains. The strange thing is that it can be asymptomatic during vigorous exercise and then produce electric jolts of pain when I'm lying in bed reading. It's unpredictable.

Ice and Ibuprofen has been helpful but I have never tried TCD's "contrast baths." I'm going to try that the next time it acts up. Surgery is a 50/50 proposition for this injury at such a late date. I've had pretty good luck with boots and I'm currently using soft-sided Merrills. I can't ever wear Nike shoes as they never fit my feet, but I have good luck with New Balance and Skechers for city walking on boardwalks and greenways. I hate to say this Day Trip, but it's part of the ageing process that your body starts breaking down like this and sometimes if you want to keep doing physical activities you have to just try and manage the pain and reconfigure your limits. Of course, when it hurts too much, or all the little pains add up to pain overload, you have to give in and stop. Or at least pause. Good luck in managing this. Maybe this enforced period of inactivity will pay dividends for you.

 

[bignslow]

Doesn't look like there is much that can be done with this. Consensus is to ice it often, elevate, take ibuprofen to reduce swelling and reduce activity. Also looks like there are orthotics out there that can help. If none of this works I guess a cortisone shot can be given and eventually if nothing works surgery is an option, which I'd like to avoid obviously. On my last hike I taped a "spacer" in between my big toe and 2nd toe and then taped them both together and that seemed to help quite a bit so I'm hopeful this is a manageable situation.

So, is anyone else out there experiencing this sort of issue and if so what types of things have you been doing to manage the situation? With the current circumstances I've been able to do the ice/elevate/stretch thing more often but I'm seeing very little result. I find heat helps more but that should in theory at least not be a good idea for inflammation but it seems to loosen it up a bit. I guess I'm hoping to find some sort of off-the-shelf orthotic that I can actually obtain right now for help because taping every day is tedious and will get expensive buying athletic tape so often. Any ideas on the topic would be appreciated. Thanks in advance.

I use "dancer's pads" which have a cut out for the ball of the big toe.
https://www.amazon.com/PediFix-Pedi-gel-Dancers-Pads-2-Count/dp/B004G8L36W

I still have pain barefoot, but with the pad, its tolerable for the usual outdoor activities.

 

[DayTrip]

I use "dancer's pads" which have a cut out for the ball of the big toe.
https://www.amazon.com/PediFix-Pedi-gel-Dancers-Pads-2-Count/dp/B004G8L36W

I still have pain barefoot, but with the pad, its tolerable for the usual outdoor activities.

Great link. Thanks!

 

[dave.m]

@DayTrip, I've got sesmoiditis (hiking) and 2 neuromas (cycling) in my right foot.

For me, good orthotics and working on gait help me manage it. What I was told is that I should strive to roll off of my middle and outer toes, not my large toe. The orthotics should help align the foot through the motion to help facilitate that and mine do, but I still need to be very conscious about my stride, particularly when wearing firm boots.

Very much related, I just got my heavy Fabianos back from a resole at Limmers and was wearing them out birding with my wife to re-break them in and end up wearing them around town a bit that day. That caused instant flare up. Dress shoes and even shoes like Dr Martens will cause my sesmoiditis to flare up. Also Keens make it flare up almost instantly. Some running shoes do too.

Luckily, I've found that (for me) Merrell Moabs keep me pretty much pain free. I have several pair including their "dressy" leather ones that I wear for everyday wear. I'm not quite old enough to wear a fanny pack in an air port (at what age exactly do you loose any sense of fashion) but at this point, I no longer care about wearing my Moabs and a blazer for (IT related) business travel. My feet stinking hurt and there aren't many shoes that allow me to walk on pavement pain free.

Bottom line for me:
Day to day shoes and walking on pavement: Merrell Moabs (in various colors and fashions)
Hiking: standard hiking boots but... not for road walks
BC and Nordic Skiing: I just suck it up

In other words, review your orthotics and stride with a good professional and find shoes that can help you stay pain free for daily life.

 

[JustJoe]

What's been weird though is that stopping the activity is what caused the pain to escalate too much. So I'm thinking/hoping that I just got stiff and loosening it up again will resolve to a point.(

Quite possible. I've had, and am now having that issue with my bad knee for the same reason. Walk 4-5 miles everyday but up and down mountains is the workout it needs.

 

[DayTrip]

@DayTrip, I've got sesmoiditis (hiking) and 2 neuromas (cycling) in my right foot.

For me, good orthotics and working on gait help me manage it. What I was told is that I should strive to roll off of my middle and outer toes, not my large toe. The orthotics should help align the foot through the motion to help facilitate that and mine do, but I still need to be very conscious about my stride, particularly when wearing firm boots.

Very much related, I just got my heavy Fabianos back from a resole at Limmers and was wearing them out birding with my wife to re-break them in and end up wearing them around town a bit that day. That caused instant flare up. Dress shoes and even shoes like Dr Martens will cause my sesmoiditis to flare up. Also Keens make it flare up almost instantly. Some running shoes do too.

Luckily, I've found that (for me) Merrell Moabs keep me pretty much pain free. I have several pair including their "dressy" leather ones that I wear for everyday wear. I'm not quite old enough to wear a fanny pack in an air port (at what age exactly do you loose any sense of fashion) but at this point, I no longer care about wearing my Moabs and a blazer for (IT related) business travel. My feet stinking hurt and there aren't many shoes that allow me to walk on pavement pain free.

Bottom line for me:
Day to day shoes and walking on pavement: Merrell Moabs (in various colors and fashions)
Hiking: standard hiking boots but... not for road walks
BC and Nordic Skiing: I just suck it up

In other words, review your orthotics and stride with a good professional and find shoes that can help you stay pain free for daily life.

Interesting. Thanks. As far as adjusting my gait the concern is that avoiding the big toe seems to be making me walk more on the outside edge of my foot, which is leaving to "half rolls" on uneven terrain. Don't want to start spraining ankles as a compensation. I still haven't purchased a real orthotic yet so maybe that will help.

 

[dave.m]

Interesting. Thanks. As far as adjusting my gait the concern is that avoiding the big toe seems to be making me walk more on the outside edge of my foot, which is leaving to "half rolls" on uneven terrain. Don't want to start spraining ankles as a compensation. I still haven't purchased a real orthotic yet so maybe that will help.

DayTrip,

My first, last, strongest, and only direct recommendation is to see at least one podiatrist who specializes in sports. Fair warning: many podiatrists mostly see geriatric patients with diabetes complications and the heat moldable orthotics they provide don't provide adequate support.

Here is my story; my experience.

My sesmoiditis is a result to my severe pronation (rolling to the inside). Both my primary arch (middle of the foot) and metatarsal arch (ball of foot) collapsed by time I was pretty young. One of the many results of this is that a) my gait naturally rolled me onto my big toe, b) this put huge pressure on my sesmoids, and c) this is what felt right to me in terms of gait.

The fix for me was 4 fold.

1) 3/4 length rigid orthotics. These took me 4 or 5 attempts with different podiatrists before I ended up with a pair that work for me. I have this pair for at least 2 years and have had them recovered several times. While hard to find, they've really helped me. I should emphasize, these provide a LOT more arch support than any over the counter insole like SuperFeet. As I noted before, these provide too much arch support for hiking as they cause blisters. I hike in SuperFeet. But for day to day wear its the rigid orthotics.

2) Metatarsal pad/drop. A standard trick for treating sesmoiditis is to create an orthotic with a "drop". One podiatrist created a custom orthotic that had a cut out for the big toe metatarsal. I've made similar ones from green (thick) SuperFeet by cutting off a portion of the forefoot. These YouTube podiatrist suggest something similar by attaching a dancer pad under the forefoot of over the counter insoles.
https://youtu.be/qS3uVUiA6U4
https://youtu.be/jzcBpK0Jxqs

Since I have neuromas, I do something different that is similar by taping a Spenco metatarsal pad to the front of my orthotic.

3) Gait adjustment. For me, "normal" has always felt like pushing off of my big toe, which puts all the pressure on the sesmoids. I've been advised to concentrate on pushing off with my other toes as being a more natural gait. My doctors' advice to me.

4) Shoes. As I noted, some shoes make the sesmoiditis worse even with the orthotics. Keens are terrible. Doc Martens are OK. Merrells are great.

Again, all of this just what works for me. My advice is to find a sports related podiatrist.

 

[DayTrip]

DayTrip,

My first, last, strongest, and only direct recommendation is to see at least one podiatrist who specializes in sports. Fair warning: many podiatrists mostly see geriatric patients with diabetes complications and the heat moldable orthotics they provide don't provide adequate support.

Here is my story; my experience.

My sesmoiditis is a result to my severe pronation (rolling to the inside). Both my primary arch (middle of the foot) and metatarsal arch (ball of foot) collapsed by time I was pretty young. One of the many results of this is that a) my gait naturally rolled me onto my big toe, b) this put huge pressure on my sesmoids, and c) this is what felt right to me in terms of gait.

The fix for me was 4 fold.

1) 3/4 length rigid orthotics. These took me 4 or 5 attempts with different podiatrists before I ended up with a pair that work for me. I have this pair for at least 2 years and have had them recovered several times. While hard to find, they've really helped me. I should emphasize, these provide a LOT more arch support than any over the counter insole like SuperFeet. As I noted before, these provide too much arch support for hiking as they cause blisters. I hike in SuperFeet. But for day to day wear its the rigid orthotics.

2) Metatarsal pad/drop. A standard trick for treating sesmoiditis is to create an orthotic with a "drop". One podiatrist created a custom orthotic that had a cut out for the big toe metatarsal. I've made similar ones from green (thick) SuperFeet by cutting off a portion of the forefoot. These YouTube podiatrist suggest something similar by attaching a dancer pad under the forefoot of over the counter insoles.
https://youtu.be/qS3uVUiA6U4
https://youtu.be/jzcBpK0Jxqs

Since I have neuromas, I do something different that is similar by taping a Spenco metatarsal pad to the front of my orthotic.

3) Gait adjustment. For me, "normal" has always felt like pushing off of my big toe, which puts all the pressure on the sesmoids. I've been advised to concentrate on pushing off with my other toes as being a more natural gait. My doctors' advice to me.

4) Shoes. As I noted, some shoes make the sesmoiditis worse even with the orthotics. Keens are terrible. Doc Martens are OK. Merrells are great.

Again, all of this just what works for me. My advice is to find a sports related podiatrist.

Thanks for the details. And I do plan to see a podiatrist when it is allowed. My wife has been dealing with major knee problems for close to 6 years now due to a workers comp battle she's been having with her employer. The place she goes is supposed to be pretty well regarded (I actually went there for my dislocated shoulder rehab) and has a foot specialist. They also have an extensive sports medicine/physical therapy side to their business so I'm hoping I can get a consultation for the toe and an overall evaluation of posture, muscle imbalances, deficiencies, etc so I can have a comprehensive "game plan" for long term hiking going forward. Just wish I could go now with all this downtime. Would have been a great time to start.