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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).
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.
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.
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.
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.
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.
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.
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.
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.