How to fix Turf Toe and Sesamoiditis injuries

How to fix Turf Toe and Sesamoiditis injuries

Why do my big toe and the ball of my foot hurt so much?

With so many Lane Cove and Sydney residents back into the full swing of sports and physical activity after a long lockdown, foot injuries are back on the rise.

Pain around the big toe and ball of the foot are common symptoms our sports specialist and musculoskeletal physiotherapists treat regularly

Two of the most common injuries of the forefoot are acute capsuloligamentous injuries at the metatarsophalangeal joint and overload injuries of the sesamoid complex.

Your sesamoids are 2 small bones within a tendon underneath the big toe joint. Putting pressure on your forefoot to move forward subjects the sesamoid bones to forces that can fracture or inflame the surrounding area. When this happens, it is called sesamoiditis.

Although commonly described in American football players, turf toe injuries are not exclusive to the NFL and have been documented in rugby, basketball, track, soccer, gymnastics, volleyball, martial arts, and dance participants.[1]

How do turf toe injuries occur?

The classically described mechanism for a turf toe injury is a load applied to a planted forefoot with an elevated heel and dorsiflexed first metatarsal joint. This load is commonly delivered by a player falling on the foot of another, creating a hyperextension force. Turf toe can also occur without an externally applied load as long as there is sufficient dorsiflexion force to create injury. These mechanisms include a player’s forefoot landing on an object (often an opponent’s foot) and during explosive cutting and push-off movements in non-contact settings.[2]

Most patients with sesamoiditis experience:

  • sharp stabbing pain in the ball of the foot
  • inability to put body weight on the ball of the foot
  • pain causing them to walk differently
  • pain in the area even when not standing
  • that the pain is made worse with activity.

How are turf toe and Sesamoiditis treated?

Given the broad spectrum of injury from mild sprain to complete capsular disruption, patients might have minor pain with pushing off the foot or to feelings of major instability and altered gait.

In general, conditions affecting the sesamoids are initially treated with rest, ice, anti-inflammatories, and offloading the hallux. Depending upon the degree of inflammation, the hallux can be offloaded with an orthotic allowing first metatarsal head or sesamoid relief, or a walking boot. Shoes with elevated heels should be avoided. Similar to the turf toe injury, taping of the toe in a slightly plantarflexed position can help to offload and support the sesamoid.

The physiotherapists at Lane Cove Physio are experienced at treating Sesamoiditis and helping to relieve the symptoms of turf toe and getting you back to previous function. Some of the treatments may include:

  • Ice/cold therapy
  • Manual therapy
  • Strengthening exercises
  • Stretching exercises
  • Advice on gradual return to previous activity
  • Advice on footwear

For an in-depth foot and ankle assessment by one of our skilled physiotherapists, book a consultation today on (02) 9428 5772 or send us an email at


[1] Frimenko RE, Lievers W, Coughlin MJ, et al: Etiology and biomechanics of first metatarsophalangeal joint sprains (turf toe) in athletes. Crit Rev Biomed Eng 40:43-61, 2012

[2] George E, Harris AH, Dragoo JL, et al: Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int 35:108- 115, 2014