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Family Foot & Ankle

Capsulitis: Second Toe Pain

Pain in the ToeYour joints are wonderfully complex constructions. Far more than a simple door hinge or ball and socket, human joints require bones, ligaments, and tendons to hold bones together and allow them to move smoothly over a normal range.

When bones come together in a joint, the supporting ligaments form a “capsule” of space that keeps the bones properly aligned and functioning normally. But over time (or due to an injury) those ligaments can become stressed, worn, torn, or inflamed—a condition known as capsulitis. Although this can happen in almost any joint in your body, it’s most common in your middle toes, particularly the second toe.

Symptoms of Second Toe Capsulitis

In the early stages, toe pain, joint pain, and swelling in the ball of your foot will be the primary symptoms. You might additionally feel like you’re constantly stepping on something, like a pebble. It may become difficult to wear shoes or walk barefoot. The symptoms are similar to a number of other painful conditions affecting the ball of your foot, particularly Morton’s neuroma.

As the condition worsens, the ligaments continue to weaken until they are no longer strong enough to keep the joint stabilized. If the second toe is affected, it will begin drifting toward the big toe, ultimately crossing over the top of it.

Causes Encapsulated

Capsulitis is generally thought to be caused by a combination of genetic factors and overuse. Although it’s not always possible to predict whether or not a foot will be affected, repetitive activities that require constant bending of the toes or placing excess weight-bearing pressure at the ball of the foot—crouching, climbing ladders, wearing high heels or other shoes that fail to provide enough support, etc.—can overstretch and weaken the ligaments in the capsule, leading to the condition.

These activities may be exacerbated by structural defects in the foot, or other inherited deformities. People whose second toes are longer than their great toes are particularly susceptible, as this foot shape places extra stress on the longer, weaker digit. The existence of bunions or hammertoes also may make capsulitis more likely.

Treatment: Don’t Toe the Line

The most important thing to understand about capsulitis is that it is a progressive disorder—that is, it will usually not improve on its own and only worsen without treatment. Furthermore, once the toe begins drifting toward its neighbor, it cannot be returned to its original position without surgery. Therefore, any persistent ball of foot pain suspected to be capsulitis should be checked by the experts at Family Foot and Ankle Center right away. The good news is that if you catch the problem early, conservative treatment options are often sufficient to stabilize your joint and minimize your toe pain.

First, try to stay off the foot as much as possible, and use ice and/or OTC anti-inflammatories like ibuprofen (if you can do so safely) to manage pain and swelling. If that’s not enough, we may prescribe tougher oral medications or administer a cortisone injection.

Simple lifestyle choices, such as investing in a proper pair of shoes and avoiding high heels or tight footwear, avoiding the kinds of activities that lead to the pain in the first place, or even losing weight can help correct the underlying issue and keep extra pressure off your sensitive ligaments.

Depending on your exact situation, our experts may recommend various treatment options. When structural problems are to blame, new shoes with stiffer soles, or inserts or orthotics that provide extra metatarsal support, are often recommended. We may also show you how to splint your toe, or tape it to its neighbor, in order to keep it firmly in place and minimize pain.

Once the toe begins drifting, it can only be corrected surgically. Our experienced surgeons will select a procedure appropriate for your condition and lifestyle.

Making the Call

Don’t wait for surgery to become your only option. If troublesome toe pain has you down, call Family Foot and Ankle Center. With six convenient locations in and around Cincinnati, we are right in your neighborhood. Set up an appointment via our online contact form, or dial (513) 728-4800 in Ohio or (859) 282-1572 in Kentucky.

Dr. Cynthia Miller
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Dr. Cynthia Miller is a board certified podiatrist who has been established in the Cincinnati area since 2004.