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Foot Bone or Joint Injury

Capsulitis of the Second Toe

Minute Read


Posted 5 months ago


Last updated: 04/12/2022


by James McCormack

Anatomy of the Second Toe

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.

Symptoms of Capsulitis of the Second Toe

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.

Causes of Capsulitis of the Second Toe:

  • Longer Second Toe than First Toe
  • Bunions
  • Abnormal Foot Mechanical
  • Repetitive overload from squatting down, running, Jumping
  • High heels and poorly fitted shoes

Diagnosis of Capsulitis of the Second Toe

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.

Capsulitis of the Second Toe: Treatment

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.

Exercises for Capsulitis of the Second Toe

Standing Gastrocnemius Stretch

  • Stand upright with the affected leg behind you
  • Keep the knee straight on the leg behind with a slight bend on the knee in front
  • Move forward on the front leg while keeping both heels on the floor
  • Stop moving forward once you feel a stretch on the back leg
  • Hold for 45 seconds
  • Repeat 3-4 times daily.

Soleus Stretch Standing

  • Stand upright with the affected leg behind you
  • Bend the back leg while keeping your heel on the floor
  • Stop and hold when you feel a pull on the back of your leg
  • Hold for 45 seconds
  • Repeat 3-4 times daily.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Related Article: Metatarsalgia: Symptoms, Diagnosis & Treatment 

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