Capsulitis
Pain and swelling generally isolated to the second metatarsal joint capsule on the bottom of the ball of the foot
Symptoms
• Pain to the ball of the foot with weight bearing activity generally involving the second metatarsalphalangeal joint region
• Subtle swelling to the base or bottom of the second toe as compared to the asymptomatic foot
• Possible swelling on the bottom of the ball of the foot region
• Occassional sharp radiating pain secondary to irritation of the common digital nerve that extends on the bottom of the foot between the second and third metatarsal regions
• May advance to plantar plate tear on the bottom of the second metarsalphalangeal joint which can lead to instability and the development of a hammertoe deformtiy
Treatment
• Supportive shoe with adequate cushioning through the ball of the foot
• Wide toe box shoe with removable liner
• Over the counter or custom orthotic with appropriate pressure relief padding to offload the painful region
• Padding designed to take pressure off of the second metatarsalphalangeal joint
• Antinflammatory medications including Ibuprofen or Naproxen taken for a limited period of time at a prescription level as recommended by your physician
• Taping of the second digit to stabilize the toe and decrease extension bending forces
• Limited use of cortisone injections into the joint with short term toe taping to decrease potential instability of the toe and development of hammertoe deformity
• Surgical correction of hammertoe deformity with plantar plate repair if confirmed plantar plate tear has been diagnosed
