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Capsulitis of the Second Toe, Inferior Metatarsal Bursitis, Lesser Metatarsal Overload Syndrome, Predislocation Syndrome

Ligaments surrounding the joint at the base of the second toe form a "capsule," which helps the joint to function properly with the articulation of the toe and the articulation of the metatarsal. Capsulitis is a condition in which these ligaments have become inflamed and cause pain with motion of the digit.
Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis-also referred to as predislocation syndrome-is a common condition that can occur at any age.

Capsulitis of the second toe is a progressive and acquired disorder and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages-the best time to seek treatment-the symptoms may include:

Pain, particularly on the ball of the foot. It can feel like there's a marble in the shoe or a sock is bunched up beneath the toes.
Swelling in the area of pain, including the base of the toe
Difficulty wearing shoes
Pain when walking barefoot



In more advanced stages, the supportive ligaments weaken leading to failure of the joint to stabilize the toe. This now unstable toe drifts toward the big toe and eventually crosses over and lies on top of the big toe-resulting in something called a "crossover toe' deformity.  This is the end stage of capsulitis. The symptoms of crossover toe are the same as those experienced during the earlier stages. Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury, overuse or trauma.

An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton's neuroma, which is treated completely differently from capsulitis.
In arriving at a diagnosis, your podiatrist will examine the foot, palpate, and maneuver it to reproduce the symptoms. The foot and ankle surgeon will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies such as MRI may sometimes be needed.

It is generally believed that capsulitis of the second toe is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight- bearing pressure. These conditions and characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.
Non-surgical Treatment

The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the great toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms of inflammation, and address the underlying cause of the condition.

  • Your foot and ankle surgeon may select one or more of the following options for early treatment of capsulitis:

    Rest and ice. Staying off the foot and applying ice packs help reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
    Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
    Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
    Stretching. Stretching exercises may be prescribed for patients who have tight calf muscles.
    Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot. Depending on the amount of swelling a CAM boot may be used.
    Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.

When is Surgery Needed?

Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed.  The specialists at Austin Foot and Ankle will select the procedure or combination of procedures best suited to each individual patient.

If you believe you have this condition, allow the expert doctors at Austin Foot and Ankle Specialists to properly diagnosis your condition and offer you options to relieve our pain. Call 512-328-8900 to make an appointment today.

Dr. Craig H. Thomajan
Founder and Managing Partner of Austin Foot and Ankle Specialists