The ligaments and soft tissue structures that surrounds the 2nd toe joint form a capsule to help the joint function properly. Capsulitis is condition in which these ligaments can become inflamed.

Common symptoms of capsulitis typically include pain and swelling on the ball of the foot and it can feel as if the sock is wadded up under the toes. The nerve tissue surrounding the joint can also become irritated and inflamed producing nerve type symptoms such as numbness, tingling, burning, and shooting pains into the toes.

There can be a variety of causes of capsulitis. In our experience, most cases are caused by excessive pronation or flattening of the arch during gait. With normal gait, the metatarsal heads will come to the ground at the same time which disperses the ground pressure evenly across the ball of the foot. With a pronated foot, the 1st metatarsal tends to be “hypermobile” which causes it to move upwards as the foot hits the ground. As this bone moves upwards, more pressure is transferred to the 2nd metatarsal which gradually causes the joint to become inflamed. This hypermobility of the first metatarsal can also contribute to the formation of a bunion and a hammertoe deformity of the 2nd toe. Poor fitting shoes or improper shoe wear may also be the cause of capsulitis. High-heeled shoes can increase pressure on the ball of the foot. Sandals and flip-flops do not generally provide sufficient support to the foot and can also increase the strain to the 2nd toe joint.

In advanced stages of capsulitis, the supporting ligaments can weaken and ultimately tear producing drifting of the 2nd toe either toward the 1st toe or the 3rd toe. The bottom portion of the joint capsule is referred to as the plantar plate. In severe and advanced cases of capsulitis, this structure usually must be surgically repaired.

What we can do to help you solve this problem
If you have pain on the ball of your foot typical of capsulitis or if you see your 2nd toe drifting, we would recommend that we see you as a patient. It is important not to ignore the pain of capsulitis as if this is left untreated, it most certainly will advanced to further instability of the joint.

Initially, we will perform a complete history and physical examination of your foot. A biomechanical examination will be performed to see what role this plays in the cause of your capsulitis. Digital x-rays will be taken to assess the bone and joint structure of your foot and to look for other problems such as arthritis or spurring surrounding the joint.

If your symptoms are not severe, conservative treatment is usually indicated. We can help to educate you on the proper shoe wear to help treat capsulitis and we can advise you on certain activities to avoid that may contribute to your symptoms. Prescription anti-inflammatory medication may be needed to reduce the inflammation associated with capsulitis and cortisone injection may be used for some cases.

The most important thing that we can do for you, though, is to fit you with the proper arch support or prescription orthotics. If your capsulitis is mild, we may be able to use a pre-made arch support to control the abnormal flattening of your arch and to stabilize your metatarsal bones. We carry arch supports in our office that are typically much better than what you will find in the store. Many cases of capsulitis will require the use of a prescription orthotic. This is a custom-made arch support that is made from a plaster impression or digital scan of your foot and arch. Unlike pre-made arch supports, however, an orthotic completely controls the abnormal flattening of the arch and most effectively stabilizes the metatarsal bones. Read more about custom orthotics.

Most cases of capsulitis can be effectively treated conservatively. If, however, you have developed a severe hammertoe or cross-over toe as a result of advancement of the capsulitis, then surgery is usually necessary. What type of surgery you will need will depend on the degree of the advancement of the condition. It is often necessary to correct the hammertoe deformity associated with capsulitis by performing arthrodesis procedure (see Hammertoe surgery). If your 2nd metatarsal is long or plantarflexed, it may also be necessary to perform an osteotomy (cut in the bone) to shorten the metatarsal to relieve pressure onto the joint. If it is determined that there is a tear in the plantar plate on the bottom of the joint, then it will likely be necessary to repair this tear by tightening up the soft tissue. Learn more about plantar plate repair surgery.

It is important to seek professional care if you have symptoms consistent with capsulitis. If left untreated, advancement of the condition occurs which can require extensive surgery to correct. The doctors at Council Bluffs Foot & Ankle Care are experts in the treatment of this condition. If you are in pain, call for an appointment. We want to help you walk without pain.

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