Professional toe wrestlers have a hard time being taken seriously. In fact, it’s even possible that they may not exist at all. But if they do, and if toe wrestling gets as heated as we imagine it might be, then it’s almost certain that, at least once during their careers, most toe wrestlers will have problems with the sesamoid bones near their big toe. (And, truth be told, people involved in more traditional sports like basketball may develop problems with these little bones as well.)

Unlike the bones in your body that connect directly to other bones at joints, sesamoid bones are actually embedded in your tendons. They occur in different places throughout your body, generally in or around joints. In the case of the big toe, the sesamoid bones are located beneath the big toe joint, in the ball of your foot. These two small roundish bones serve a couple of different purposes, including protecting the large tendon that runs between them, providing leverage for pushing your big toe against the ground when you take a step, and bearing weight for the bone just above them (the first metatarsal) during activities such as running, jumping, and walking.

Like any bone, the sesamoid bones near the big toe and the tendons in which they reside may become injured when stressed. When a great deal of pressure is put on the ball of the foot, such as when you have high arched feet, or in sports (like basketball, baseball, or tennis), ballet, walking in high- heeled shoes, or during intense toe-wrestling sessions, the sesamoid bones in the big toe can fracture, or the surrounding tendons may become inflamed.

One common injury involving the sesamoid bones is turf toe. Turf toe happens when the big toe becomes overextended and the soft tissues surrounding the big toe joint get stretched out or rupture. It may even lead to fracturing of the sesamoid bones themselves. The sesamoid bones may also break from other causes (such as when that toe-wrestling match get ugly). The break may be acute (it happens suddenly due to trauma) or chronic (cracks develop in the bone over time, usually from overuse or constant stress to the bones, such as when you ignore your podiatrist’s advice and wear high-heeled shoes while jogging).

The symptoms of sesamoid injuries will vary a bit, depending on the type of injury you have. For instance, turf toe tends to manifest itself as sudden sharp pain in the big toe which may occur as you push your foot off the ground while running. You might experience a popping sensation when you injure your toe. Turf toe is also accompanied by swelling, pain throughout the big toe, restricted motion of your big toe, and sometimes (with more severe injuries) bruising.

If your sesamoid bones break under pressure, you may experience sharp sudden pain (if the fracture is acute) or more gradual, long-lasting pain beneath the joint of the big toe (if the fracture is chronic). Acute fractures may also be accompanied by swelling, although this swelling and the pain of the fracture will be localized near the bones themselves and probably won’t spread throughout the toe joint. Pain from chronic fractures may improve with rest and then get worse as you go around putting weight on your feet.

Sesamoiditis, or inflammation of the tendons surrounding the sesamoid bones, is often associated with certain types of activities or wearing certain types of shoes (such as, surprise, surprise, high heels). Pain will probably be dull and long lasting in the ball of the foot beneath the big toe joint. Ballet dancers, baseball catchers, and runners, as well as those with high arched feet may be susceptible to this type of injury.

Approximately 6 out of 10 podiatrists are convinced that pro toe-wrestling doesn’t actually exist, but they sure know that sesamoid bones are real, and that they can be injured. When you go in to see your foot doctor, he or she will probably take a history of your symptoms, and will perform a physical examination of your foot. This may involve pressing on the area around your big toe joint (more specifically on the sesamoid bones themselves), moving your big toe, and checking for visual signs such as redness, swelling, and bruising. Your podiatrist may also ask you to walk around, and may check your shoes for patterns of wear. He or she may order X-rays or other imaging studies to get a better look at your bones.

In order to allow your sesamoid injury to heal, you’ll first need to take a break from whatever activity is causing you pain. (In short, give toe- wrestling a rest.) Depending on the type and severity of your injury, your podiatrist will likely try to treat it using conservative means before recommending surgery. These conservative treatments include taking aspirin or ibuprofen to relieve the pain, applying ice (over a thin towel) to the area or using a steroid injection to reduce swelling, padding the area around the sesamoid bones to reduce pressure on them (this may include using orthotics), taping the big toe joint or using a cast to keep it immobile, and physical therapy.

If these treatments fail to adequately improve your symptoms, your podiatrist may suggest surgery to remove the sesamoid bones entirely, or to repair the surrounding soft tissues of the big toe joint.