Capsulitis of the Second Toe (Plantar Plate Injury)
Capsulitis is a condition in which the capsule of a joint is inflamed. The capsule of a joint holds the joint together and helps with the movement. The 2nd toe joint is prone to capsulitis because, aside from the big toe joint, it bears more weight than all the other toe joints. When the big toe joint is dysfunctional, the 2nd toe joint shares the weight, and can become overloaded.
Cause:
The cause of 2nd toe joint capsulitis is a result of abnormal foot mechanics. Abnormal foot mechanics can stem from severe bunion deformities, a second toe longer than the big toe, unstable foot, and tight calf muscles.
Symptoms:
Capsulitis of the 2nd toe is a gradual and progressive condition. As the condition worsens, so do the symptoms. Symptoms can include the following:
Diagnosis:
The symptoms of capsulitis of the 2nd toe are similar to Morton’s neuroma. A careful examination of the foot is important. Certain maneuvers can be performed to reproduce the symptoms. The stability of the 2nd toe joint can be assessed. If necessary, imaging such as X-ray, ultrasound, or MRI may be ordered.
Treatment:
If the capsulitis is diagnosed early, conservative treatment is effective. Treatment can include the following.
As the deformity progresses, and the 2nd toe drifts onto the big toe, surgery may be considered. Surgery for correction of the 2nd toe might involve concurrent correction of the big toe deformity.
Capsulitis is a condition in which the capsule of a joint is inflamed. The capsule of a joint holds the joint together and helps with the movement. The 2nd toe joint is prone to capsulitis because, aside from the big toe joint, it bears more weight than all the other toe joints. When the big toe joint is dysfunctional, the 2nd toe joint shares the weight, and can become overloaded.
Cause:
The cause of 2nd toe joint capsulitis is a result of abnormal foot mechanics. Abnormal foot mechanics can stem from severe bunion deformities, a second toe longer than the big toe, unstable foot, and tight calf muscles.
Symptoms:
Capsulitis of the 2nd toe is a gradual and progressive condition. As the condition worsens, so do the symptoms. Symptoms can include the following:
- Pain at the ball of the foot. Patient complains of discomfort like a marble in the shoe, or bunched up socks
- Swelling at the base of the toes
- Difficulty with wearing shoes, especially high-heeled shoes
- Pain when walking barefoot
- 2nd toe drifting toward the big toe
- 2nd toe lying on top of the big toe
- Acute pain at the bottom of the 2nd toe
Diagnosis:
The symptoms of capsulitis of the 2nd toe are similar to Morton’s neuroma. A careful examination of the foot is important. Certain maneuvers can be performed to reproduce the symptoms. The stability of the 2nd toe joint can be assessed. If necessary, imaging such as X-ray, ultrasound, or MRI may be ordered.
Treatment:
If the capsulitis is diagnosed early, conservative treatment is effective. Treatment can include the following.
- Rest and ice. Staying off the foot and applying ice packs help reduce the swelling and pain. Apply an ice pack and 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.
- Orthotic devices. Custom shoe inserts are often greatly beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.
As the deformity progresses, and the 2nd toe drifts onto the big toe, surgery may be considered. Surgery for correction of the 2nd toe might involve concurrent correction of the big toe deformity.