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There are five toes in the foot, and the second toe is the longest. It plays a vital role in the structural integrity of the foot, and where the 2nd metatarsal meets the pharyngeal bone, it is known as a metatarsophalangeal joint (MTP). Around this joint is a capsule that consists of thick connective tissue and ligaments, providing stability to the joint. However, if this joint capsule becomes irritated, it becomes inflamed, leading to Capsulitis of the second toe. It is possible to have Capsulitis of the middle toe and the fourth toe, but Capsulitis of the second toe is more common.
In an acute episode of Capsulitis of the Second Toe, there is swelling on the ball of the foot, with patients often describing that they have a pebble or stone in their shoe. Symptoms are irritated by walking in high heels, tight-fitting shoes, or on uneven surfaces.
Activities like running, skipping, and ballet can irritate the symptoms of Capsulitis. Symptoms should improve with rest, but there may be a constant pain in severe cases, even when non-weight bearing.
A foot specialist clinician can diagnose Capsulitis of the Second Toe based on a clinical interview and a Physical Examination. A big part of the physical examination is ruling out other conditions that cause pain in the ball of the foot, such as Morton’s Neuroma or a fracture. It is not unusual for a clinician to refer for imaging to confirm the diagnosis. An ultrasound or an MRI are the most effective scans to identify swelling of the capsules while ruling out other conditions in the forefoot. An x-ray can rule out other conditions, but it cannot diagnose Capsulitis of the Second Toe.
Home treatment in the initial instance consisting of icing, rest, cushioned shoes and anti-inflammatories works well to settle most cases. If this is unsuccessful, a consultation with a Podiatrist or a Physical Therapist is recommended. An assessment of your foot and ankle strength and mobility combined with a gait assessment can identify abnormal foot mechanics contributing to your pain.
Taping is an effective method of pain relief for Capsulitis which involves a ribbon taping method to provide resistance from toe extension.
Stretching exercises of the calf muscle can be highly effective at reducing the speed of weight transfer onto the forefoot when walking or running while strengthening and stability exercises can help control any excess pronation moments that may contribute to an overload of the Second MTP joint.
Advise from your therapist on the best shoes for Second Toe capsulitis can provide pain relief alongside a custom insole. In a minority of cases, a corticosteroid injection may be recommended to reduce inflammation in the joint; in severe cases, a period of 2 weeks is recommended in a walker boot followed by 4-6 weeks of Physical Therapy.