Another forefoot problem that causes pain in some individuals is irritation, imbalance or fracture of 2 small bones in the front of the foot that are largely unknown to most people. These 2 bones are called sesamoids and they sit directly below the 1st metatarsal bone in a normal foot. They function like kneecaps for the big toe joint.  In a foot that is imbalanced or too flexible these 2 bones may bear too much pressure and become fractured. They have special grooves on the bottom of the 1st metatarsal that they are supposed to function within to keep the big toe straight.  In flat feet, flexible feet and feet with bunions, the sesamoids will move out of their special grooves and start wearing away cartilage and bone.  Orthotic therapy is very beneficial to help remove pressure from overloaded sesamoids and to help rebalance the foot. People with sesamoiditis often limp and try to walk on the outside of their foot to remove pressure from their painful sesamoid.  This is a dangerous compensation as it often causes pain and disability at another joint level like the knee, hip or back, or some other part of the foot.  A person with untreated sesamoiditis often relearns how to walk in an unbalanced fashion.  Treatment should be sought early if sesamoiditis is suspected