We recently treated a client who presented with highly pronounced high arches (Cavus Foot). Visually, his high arch structure was unmistakable. Upon closer inspection, we noticed that tightness in his shin muscles was exacerbating the condition—his clawed-under little toes were a classic sign of this tension.

This specific foot alignment ultimately forced excessive pressure onto his forefoot, triggering an incredibly painful condition: sesamoiditis.

What is Sesamoiditis?

The sesamoids are two tiny, pea-shaped bones embedded within the tendons beneath the big toe. Their job is to act like pulleys, absorbing shock and helping the big toe bend. Under normal circumstances, they work quietly in the background, and we never even notice they are there.

However, when foot structure is misaligned or when weight distribution is uneven over time, these tiny bones are subjected to excessive pressure and friction. This leads to painful inflammation, known as sesamoiditis. The pain can be sharp and debilitating—in severe cases, even walking a few steps becomes agonizing, feeling as though you are stepping on a sharp pebble right under your big toe.

How Do High Arches Lead to Sesamoiditis?

A high arch means the middle of the foot is raised off the ground, significantly reducing the foot's contact area. Rather than being distributed evenly, shock and weight are forced heavily onto the heel and the ball of the foot (forefoot). This constant, localized pressure is a primary cause of sesamoiditis.

In our client's case, the situation was further complicated by tight shin muscles. The tension in these muscles pulled upward on his toes, causing them to claw and curl downward. This shift concentrated the pressure point on his forefoot even more, creating a painful, self-reinforcing cycle.

Our Treatment Approach

To address this client's unique condition, we designed a comprehensive, multi-faceted recovery plan:

Custom-made orthotics (insoles) were our first line of defense. By providing tailored, contoured arch support, they redistribute weight across the entire foot, taking direct pressure off the inflamed sesamoids to offer immediate relief during daily walking.

Shockwave Therapy and Tecar Radiofrequency Therapy were targeted at the inflamed soft tissues. These physical therapies stimulate local circulation and accelerate cell repair, addressing the root cause of the inflammation.

Active Rehabilitation is key to long-term recovery. Passive therapies alone are not enough; we need targeted exercises to correct the muscle imbalances causing the issue. This involves stretching the tight shin muscles and strengthening the weaker muscle groups to restore overall balance to the feet and lower limbs.

Stretch for Tight Shins

In this client's personalized exercise programme, the following stretch was prescribed to target tight shin muscles (tibialis anterior), helping to ease toe curling and relieve pressure on the ball of the foot.

If you suffer from high arches, forefoot pain, or claw toes, you can try this simple stretch at home:

• Sit or stand, and place the top of your foot flat against the floor.

• Gently press your toes and the top of your foot down toward the ground until you feel a comfortable stretch along the front of your shin.

• Hold for 30 seconds, and repeat 3 times.

You should feel a mild to moderate stretch, never sharp pain. If you experience any discomfort, stop immediately and consult a professional.

Don't Ignore Foot Pain

Many people try to "grin and bear" foot pain. However, conditions like sesamoiditis will only worsen without early intervention. This can cause you to alter the way you walk, leading to secondary compensatory pain in your knees, hips, and lower back.

Your feet are your foundation—how they move impacts your entire body. If you have high arches, forefoot pain, or notice your toes starting to curl, book a comprehensive foot assessment with us today. Let us identify the root cause and build a recovery plan tailored to you.

Every step you take should be pain-free.