Pain in ball of foot under big toe. Sesamoid injury?

Posting here to see if anyone had similar experience. 

Earlier this week on the last pitch of an alpine climb, I felt sharp pain in the ball of my right foot all of sudden, seemingly out of nowhere. I didn't know what caused it, but I couldn't put weight on the ball of foot anymore. Luckily the climbing was easy enough at that point. The pain eased after a while and I was able to hike out just fine with minor discomfort. A couple days later I went cragging, and felt that pain again on the start of the first climb but it soon went away. However, after my last route of the day as I took off my climbing shoes, some really intense pain on the ball of my right foot under the big toe occurred, and made it extremely painful to take off my shoes. I hiked out the crag limping, and am still limping after a couple days as I couldn't put weight on the ball of my right foot still. 

Google tells me I might have injured sesamoid. Has anyone had similar experience before? I'll go see a doctor if it doesn't improve in a few days. 

I had this after a slabby whip a few years back, but sounds like it wasn't as bad as your injury. It hurt to use certain footholds but walking was okay after the first week or so. I kept climbing and 6 months later I realized the pain had gone away.

Not sure if that's helpful, but hopefully you can identify a cause and mitigate it. Stiff shoes might take some stress off that zone as your toes won't work as hard. 

Sounds familiar. Hairline sesamoid fracture? Got mine diagnosed pretty fast with an x-ray. Apparently these often never heal unless the foot is splinted soon after injury. Like the post above, good shoes and shoe inserts which take the pressure off that area helped me. Time to find a podiatrist!

I just went to see a podiatrist. X-ray looks fine, but he said stress fractures don't always show up on x-ray.... Now I'm going to wear a boot for 2 weeks and see if it improves. 

Ive been dealing with this for a few years on and off but climbing seems to aggravate it. Thought it might be turf toe but the length of time suggests it might be a chronic issue (sesamoiditis/ fasciitis.) To combat it Ive been wearing stiffer shoes (boostics) and going to try some acopa jb’s 

Lately Ive been thinking a good bit of the pain might be residual mental pain in otherwise healed tissue, so am going to try focusing on strengthening the foot and telling myself the pain is psychological. Good luck!

Have you looked into a Mortons Neuroma? Sounds kinda similar except mine happened originally in winter snowboarding so I can't compare how it would've felt in my climbing shoes. Felt to me like there was a rock in my boot and causing nerve pain then my whole foot felt like it was asleep by the end before I had it removed. I let it go on for WAY to long. 

I had similar symptoms from October of 2019 to June 2020. I finally caved and went to a foot doctor. She did an xray and ruled out a fracture. She diagnosed it as a capsulitis issue and I took two rounds of oral steroids. Cleared up in a few weeks. 

I got the sesamoiditis from running downhill in evolv cruisers in the summer of 2018. It shut my climbing down for a while.

There's a KT taping method that really does wonders, get sesamoid pads and try to stay in stiff sole boots for a while. It's a long process to get it to heal. Climbing and big days on your feet are very bad for the injury. My Ortho put it pretty bluntly that if I didn't lay off it, it would permanently shut down my career. 

After a couple months of keeping it taped, in stiff sole boots, with sesamoid pads, and laying off all activities on my feet, I got the idea that getting a wide lasted ski boot punched out around the ball of the foot might work. That did wonders for keeping me active while it had a chance to heal. I was able to tolerate a ton of touring with it taped up. You live in a place you can do this, and the timeline lines up with you taking a couple months off to let it heal before the season starts. I highly recommend switching to skiing to not go crazy while it heals. 

As I started climbing and hiking the next summer, I had to change how I did shoes... No more approach shoes, just roomy trail runners. It's made me pretty religious towards Altras with rockplates for big days. I sized up my climbing shoes and can't wear anything with a downturn. Despite the changes my climbing season was still severely limited by the injury and I didn't get out much.

After cycling through another season in ski boots though, it's finally healed a ton. I can run again, and I've been hitting some long routes with big approaches. It still can be an issue. I have to be mindful of how I step on rocks hiking, and how I use my foot on holds, especially in hand cracks. But I'm climbing harder slab than I have before, and I'm starting to train for the ultra the injury took me out of.

I'm on my phone and this is the best description I could find of how my Ortho taught me to tape it.

Method 1: Taping The Big Toe To Limit Range Of Motion

In order to tape the big toe to limit it’s range of motion:

1. Measure and cut a piece of kinesio tape from the tip of the big toe to the middle of the arch of the foot.
2. In order to make a y-strip from this piece of tape, cut down the middle of the tape (length wise) up to a length of 2 inches. This will for a strip that looks like the alphabet Y, with two 2 inch arms and a long trunk.
3. Tear the backing paper from the arms of the y-strip. Then, place the base of the y-strip at the base of the big toe.
4. Bring the arms of the y-strip over and around the big toe. The y-strip should sit around the base of the big toe like a tie.
5. Remove the remaining backing paper from the kinesio tape, leaving the last 2 inches on. These 2 inches constitute the anchor point of the kinesio tape. Anchor points help the tape stick to the skin and must be applied with absolutely no stretch.
6. After removing the backing paper upto the anchor point, apply the rest of the tape to the arch of the foot using 20% stretch.
7. You can then peel off the backing paper from the anchor point, and lay it down on the foot using absolutely no stretch.

You should feel a slight amount of tension on the big toe pulling the big toe downward. This is normal and is evidence that you have applied the tape properly.

It is important to note that the tension should not be too much. The toe should be able to move with relative ease in the opposite direction when force is applied to it.

The objective of limiting range of motion is two fold. Over extending the big toe exerts more pressure on the sesamoids during toe-off. The other reason for limiting range of motion, is re-position the natural sub-metatarsal padding under the big toe. This protects the sesamoids by reducing impact and providing extra cushioning.

I had something similar that I self diagnosed as turf toe a common injury in the NFL.

Ice water bath daily and loose climbing shoes with firm footbed support and 1 month helped much.

Thank you so much for sharing, Russ! 

Pretty ingenious idea with the ski boots... however, I mostly snowboard at resorts, but was looking to get a splitboard this year. 

I just started taping, and was given a boot. I haven't been very religious about wearing it, but my podiatrist said I needed to be in the boot 24/7 for a few weeks if I wanted a chance to heal. I have a trip coming up to red river gorge in 6 weeks, and it's probably not gonna happen anymore =( 

Can we please get an update? How did all the things you tried work out for you? A lot of threads about sesamoid injuries end with plans and no results--makes it hard for us future sufferers to make the right kind of plans for our own sesamoid injuries. I'd really appreciate if you could let us know what worked and what didn't and how long it took to go away, if it ever did! I hope it did!

I fractured my tibial sesamoid in a fall last April. Spent 9 weeks in a walking boot and a homemade orthotic to relieve pressure on the bone, was cleared by my podiatrist at 8 weeks to resume activity but I played it safe and didn’t really do anything other than very careful walking with the orthotic until 10 weeks out. I did climb in the gym with the boot. 12 weeks out I climbed some easy stuff outside and by the end of the summer I was able to do a climbing trip to Tuolumne (with lots of hiking) just fine. I tried to avoid any hard jamming that would put pressure on the bone, until I was about 6 months out. I’m 100% now.  Let me know if you want any more specific details and I’d be happy to share.

I had a non healing fractured medial sesimoid that was treated conservatively for a couple years before I had a resection surgery. I'm just now, after 14 months,  able to spend any tune in climbing shoes and still mostly wear mountain boots rock climbing.  Skiing had been no issue.  I believe I had the entire gambit of treatment options if you want to reach out feel free to message me. I also know another guide who had his medial sesimoid removed and was able to return to climbing after a year or so but uses a funky orthotic in climbing shoes. I'm also considering this option.

I had this same problem from Nov-Jan. It started after running a 50k, undertrained.  I too thought it was Sesamoid.  Turns out it was tendinitis in my FHL tendon.  There’s some good stretches you can do and foam roll your calf.  Works miracles 

Liz Thelander wrote:

Can we please get an update? How did all the things you tried work out for you? A lot of threads about sesamoid injuries end with plans and no results--makes it hard for us future sufferers to make the right kind of plans for our own sesamoid injuries. I'd really appreciate if you could let us know what worked and what didn't and how long it took to go away, if it ever did! I hope it did!

Hi Liz! 

I haven't been checking this thread for a while.. so I recovered pretty well in a walking boot, and was able to get back to climbing about 2 months after the injury. Although I had to avoid slab climbing for a few more months. After that I had no issue with it for a year or so, until it flared up again after a sport climbing session with no obvious reasons. So I took it easy for a while and it went away, and hasn't happened since. There was no fracture, so I guess that's why it healed pretty quickly. 

Go see your doctor . . .

feifei J wrote:

Hi Liz! 

I haven't been checking this thread for a while.. so I recovered pretty well in a walking boot, and was able to get back to climbing about 2 months after the injury. Although I had to avoid slab climbing for a few more months. After that I had no issue with it for a year or so, until it flared up again after a sport climbing session with no obvious reasons. So I took it easy for a while and it went away, and hasn't happened since. There was no fracture, so I guess that's why it healed pretty quickly. 

Thanks for the update!

So I've had just about the same trajectory... Injury, long recovery, finally feeling 90% better, then recent random bad flare up after a normal climbing day.

I took about 3 months off after the initial injury (early December '22). Have been in PT for it (and a couple of other injuries that came after such a long break from climbing, unfortunately) since then. 

As of last month, I was nearly pain free. Then randomly last week I reinjured it BADLY, doing nothing out of the ordinary. Like, at least as much pain as the original injury. But this time it's a little different--the pain and swelling is mostly under and around the big toe, including the sesamoids but now involving the other tendons. I suspect tendinitis at this point.

So for the past several days my treatment has been rest, daily contrast baths, massage, and a voltaren/arnica gel combo slathered on in the morning and at night. And naproxen when the pain and swelling are just ridiculous.

That's my update--hopefully I have good news later on, i.e. I hope this flare up goes down faster than the initial injury.

Definitely going to make my PT exercises a part of my daily pre-hab routine forever. Because this is stupid.

elvish yadav wrote:

Doctors hoping you'll come in for treatment of that 'yoga injury' say that's the case. As a teacher, none of my students have approached me with this. Soreness isn't uncommon as people are getting started, but as long as stretch doesn't turn to over-stretch, any muscle weakness generally resolves with continued practice, sometimes with modification. This is one to take to a podiatrist, preferably without mention of what you're thinking it is, but showing them what specifically you feel may be causing or exacerbating the problem, and let them work from there.

What yoga injury? What students? Getting started with what? Are you replying to the right thread?

I did go to a podiatrist, way back in December, and he confirmed I injured the soft tissue around my sesamoids. Ongoing issue now. Notoriously difficult to heal. It is getting better, though. That random injury a month ago was bad, but this week it is good. I climbed the last two days in a row without issue. That's just now it is now.