Pain located below the big toe and first metatarsal (the bony prominence on the inside of your foot) may be caused by sesamoditis, an inflammation of one or both small bones located in a tendon. In normal anatomy, the sesamoid bones below the big toe protect and stabalize the tendons that protect the tendons that pull the toe against the ground during ambulation. Because these small bones are located at a point of great pressure, they can become inflamed, fractured, or thickened.
High impact activities that involve running or jumping can predispose someone to sesamoditis. High heeled shoes extenuate the pressure on the sesamoids as well, and can be the source of patient pain.
It is important to have imaging performed on patients with suspected sesamoditis to rule out fractures. Treatments include off-loading the sesamoids with a custom orthotic, physical therapy, and cortisone injections.