What is Second Toe Capsulitis (Predislocation Syndrome)?  

Capsulitis in the foot is an inflammation of the ligaments near the toe joints, brought on by excessive force. at the forefoot. Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. The condition results from abnormal foot mechanics, where stress is placed on the joint at the base of the second toe. This weakens the ligaments and capsule, as well as the fibrous support known as the plantar plate. The structures stretch over time, and the condition generally gets worse. If left untreated, it can eventually cause dislocation of the toe which can result in a upwards sitting toe or cross-over toe. Rarely, a direct trauma to the stabilising structures can result in the condition much faster. Capsulitis – also referred to as pre dislocation syndrome – is a common condition that can occur at any age.

Symptoms of Second Toe Capsulitis

Because capsulitis of the second toe is a progressive condition and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages (which is 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 or pebble in the shoe or a sock is bunched up under your forefoot.
  • Swelling in the area of pain, including the base of the toe.
  • Difficulty wearing shoes.
  • Pain when walking, particularly barefoot.
  • Instability of the second toe (cock-up toe or crossover toe).
Symptoms of capsulitis can mirror other foot conditions, including neuroma’s, so it is important for you to see a podiatrist for a clear diagnosis..

Causes of Second Toe Capsulitis 

Capsulitis of the second toe is a result of abnormal foot mechanics, where the area beneath the toe joint takes an excessive amount of weight-bearing pressure. Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot, in the area of the second toe joint. These most commonly include:
  • severe bunion deformity,
  • having a second toe longer than the big toe,
  • structurally unstable feet, such as flat feet.
Some lifestyle activities such as climbing ladders and engaging in activities that require kneeling, like gardening or working low to the ground, can overstretch the ligaments near the toes and produce inflammation.Wearing high heels or unsupportive shoes can also cause excessive bending of the toes and inflammation of the joints.

Conservative Treatment of Second Toe Capsulitis 

The best treatment outcomes for capsulitis are achieved in the early stages of the condition, before the toe starts to drift toward the big toe. So it is important you seek podiatric advice if you suspect you or someone you know has Capsulitis. In the early stages, non-surgical approaches can be used to stabilize the joint, reduce the symptoms, and address the underlying cause of the condition. Once the toe begins to drift, conservative treatment options become less effective and a surgical option has better outcomes.The following are options for early treatment of capsulitis:
  • Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming or the  AlterG Anti-Gravity Treadmill. Continuation of training on the AlterG to decrease the load on the foot and its surrounding muscles whilst maintaining an exercise program.
  • Heat or Ice.  This condition may respond better to either heat or ice. Try heat prior to exercise and Ice afterwards.
  • Oral medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, may help relieve the pain and inflammation. It is advised that you discuss this option with your GP.
  • 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.
  • Exercise program. An exercise program may be prescribed for patients to address muscle weakness or joint restrictions.
  • 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 therapy. Custom orthotic devices can be beneficial. These  may include special modifications to address biomechanical abnormalities or re-distribute pressure away form the painful joint to reduce pain and progression of the condition.