Capsulitis of the Second Toe: Symptoms, Causes & Treatment

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.

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.

Capsulitis of the Second Toe