Many patients come in and complain that they have vague pain in the ball of the foot. Many times it feel like it is across the whole ball of the foot, but sometimes it is focused on the 2nd toe. What could this be? It could possibly be a condition called capsulitis. Capsulitis is defined as inflammation of the joint capsule, or of the ligaments surrounding the base of the 2nd toe where it attaches to the long bone of the foot, or the metatarsal.
Symptoms of capsulitis include pain in the ball of the foot, described sometimes as "stepping on a marble" under the 2nd toe. The pain is described as aching, and is worsened with bending the toe or wearing heels. It is also worse when barefoot or on hardwood floors. Sometimes you may see it with a concurrent 2nd digit hammer toe, or when the 2nd toe is cocked up. If the 2nd toe is rigidly contracted, it can also appear to be dislocated. Capsulitis is cometimes refered to as "predislocation syndrome" because it can lead to a 2nd digit dislocation if not treated.
The cause of capsulitis in the 2nd digit basically comes down to the biomechanics of the foot. Various conditions may place undue stress on the 2nd toe joint, such as a bunion deformity where the big toe pushes up against the 2nd toe joint, or if the 2nd toe is longer than the 1st. Sometimes an unstable arch may cause collapse of the inside of the foot causing instability and increased pressure on the 2nd toe joint as well. Often times these are aggravated by increased activity, a new activity, or improper shoe gear or lack of support.
Diagnosis of this condition is made by physical exam, Xrays, and observation of the foot structure. It is important to get an accurate diagnosis as pain in the ball of the foot could also be a bony abnormality or even a neuroma, which would render a different treatment plan. Xrays are taken in our office to rule out a fracture or stress fracture, and to observe the quality of the joint and the bones.
Treatment of this condition must employ methods to decrease inflammation and to correct the biomechanics that lead to this diagnosis. At the first visit, we start with strapping and padding, icing the area, and oral anti inflammatories. If this is improving, we may also add physical therapy and an in-office procedure called iontophoresis. We will also discuss the benefits and risks of a cortisone injection in the 2nd toe joint to alleviate the pain. In order to address the biomechanics, we may suggest orthotics, or inserts, in the shoe. Our doctors and medical staff fit our patients with custom orthotics, but sometimes over the counter options with alterations may work as well. If no progress is seen, then we may send patients for advanced testing such as diagnostic ultrasound or an MRI to make sure the plantar plate, a ligament that holds the 2nd toe joint in place, is not torn. In such cases, either immobilization with a CAM boot or sometimes surgery may be warranted.
If you have pain in the ball of your foot, make an appointment with one of our doctors today. You should not have to live with pain! Call Prairie Path Foot and Ankle Clinic 630-834-3668.