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Foot Bone or Joint Injury

Capsulitis of the Second Toe

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Posted 1 year ago


Last updated: 09/11/2023


by James McCormack

James McCormack
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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).

The MTP joint of the second toe is a hinge joint and around this joint is a capsule that consists of thick connective tissue, synovial fluid and ligaments, providing stability to the joint. The second metatarsal bone is subjected to a high bending moment with a resultant force of about 45% body weight acting on its head.

It is possible to have Capsulitis of the middle toe and the fourth toe, but Capsulitis of the second toe is more common.

This article will explain the symptoms and risk factors associate with capsulitis of the second toe along with the best treatment recommendations.

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.

Risk factors include impact activities such as running, skipping, and ballet can irritate the symptoms of Capsulitis.

Symptoms should improve with rest, but there may be constant pain in severe cases, even when non-weight bearing.

There may be stiffness first thing in the morning when you walk after getting out of bed.

Causes of Capsulitis of the Second Toe:

  • Longer Second Toe than First Toe
  • Bunions can cause reduce range of motion at the forefoot and place additional stress on the second metatarsal
  • Abnormal Foot Mechanics
  • Repetitive overload from squatting down, running, Jumping
  • High heels and poorly fitted shoes
  • Obesity can lead to extra stress on the forefoot.
  • Hammertoes can lead to a drop in the metatarsal heads causing excess pressure
  • Tight calf muscles can lead to excess pressure on the forefoot.

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 important 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. We would expect there to be pain on palpation of the second MTP.

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

As capsulitis is primarily an inflammatory condition, if you have received an appropriate diagnosis from a health care professional it can be worthwhile trying a home treatment in the first instance.

  • Icing and rest: icing for 15-20 minutes on the underside of the foot 4-5 times daily can help to reduce pain levels and swelling in the MTP joint. Resting from impact activities and avoiding narrow shoes or high heels can make a substantial difference in pain levels.
  • Anti-inflammatories: such as ibuprofen can reduce inflammation levels and pain but you should consult your GP before taking any.
  • Metatarsal pads or off-the-shelf insoles can reduce pain levels by altering the transmission of force when walking.

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.

Strengthening exercises of the Flexor Hallucis Longus, Posterior Tibial Tendon and short intrinsic muscles of the foot can be helpful.

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.

Capsulitis Foot Exercises

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.

Can you run with Capsulitis of the Second Toe?

You should stop running if you have Capsulitis of the Second Toe, which is painful when running, especially if the pain becomes more significant as you run further. If you have no pain when running or mild pain afterwards that subsides within 24 hours, then running with a cushioned trainer can be okay. Still, we recommend consulting your Physical Therapist before doing so.

Can you exercise with Capsulitis?

Yes, you can swim and cycle with Capsulitis of the toe. Swimming is a non-impact exercise that puts minimal to no force through the capsule of your second toe, so it is highly unlikely to aggravate your symptoms. When cycling, use cleats, stay in the saddle and cycle on flat surfaces to minimise the force on the forefoot.

Physiotherapy with James McCormack

This article is written by James McCormack, a Lower Limb Specialist who is an expert in treating Capsulitis of the Second Toe.

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack if you are experiencing any of the symptoms discussed in this article. James offers Online Physiotherapy Appointments weekly and face-to-face appointments in his London clinic.

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