How to Diagnose and Treat a Capsulitis of the Second Toe

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Have you ever felt that there's a rock under the ball of your foot, just behind your second toe? It may be an inflammatory condition called capsulitis. My name is Dr. Andrew Schneider and I'm a podiatrist in Houston, TX. Capsulitis is a common cause of pain in the ball of your
foot. In today's video, I'm going to discuss what capsulitis is, how it's diagnosed and how it's effectively treated.
Around every joint, there are ligaments that support it. At the joints in the ball of your foot between the metatarsal bones and the toes, the joints is enveloped by ligaments. These ligaments are known as a joint capsule. Inflammation of the joint capsule is called capsulitis while capsulitis can technically happen in any of the toe joints. It's most commonly found in the second toe. It can become very painful, and if not treated, it can cause the joint to weaken and lead to further issues that may have to be treated surgically.
Capsulitis is caused by faulty foot mechanics that leads to a greater load beneath joint of the 2nd toe. The joint could be overloaded
because of issues at the great toe joint. If there a limited motion in the great toe joint, the pressure shifts over to the 2nd toe and overloads it. This also can happen if you have a bunion deformity, same situation. The great toe joint is compromised and the pressure shifts to the second toe joint.
Symptoms of capsulitis present as pain in the ball of the foot, right behind the second toe. It often feels like you're walking on a marble. There's often observable swelling at the ball of the foot. Women often have pain, especially when wearing high heeled shoes. There is also pain common when walking barefoot on hard floors.
When you come in with possible capsulitis, I'll be sure to take an x-ray. That will rule out other causes of the pain, such as a stress fracture. The actual diagnosis is clinical in nature. I'll press on the affected joints and see if I can reproduce the pain that you're feeling.
In terms of treatment, we have to focus on two sides of the situation. First is managing the inflammation. This can be done using oral anti-inflammatory medication or with a corticosteroid injection around the joint. Applying ice is also a natural way to achieve anti-inflammatory effect. Just don't use ice longer than 20 minutes at one time.
Next we have to manage the mechanics that is causing the capsulitis in the first place. Taping the toe to prevent it from flexing up will help to support the joint and reduce the pain. That's temporary, but a good lead in until we pursue a more permanent solution in the form of custom orthotics. Custom orthotics are custom insoles that will redistribute pressure away from the overloaded area. They're very effective long term
solution to preventing capsulitis from returning.
Finally, we have some newer treatments. One of the most effective is extracorporeal shockwave therapy. This non-invasive, painless treatment sends thousands of shockwaves into the inflamed area. This increases the blood flow to the injured site, bringing along with it factors to allow your body to heal the inflamed tissue. This generally leads to a stronger, more effective and more longstanding resolution.
There is no surgical treatment for capsulitis. If capsulitis is not treated in a timely manner, it can lead to a weakening of the ligaments and worsening of the condition that will be discussed. In next week's video, then I'll discuss the next stage of this condition which is a rupture of the ligament known as the plantar plate.
#Capsulitis #plantarplate #shockwavetherapy
00:00 Introduction
01:10 What is Capsulitis
01:41 Causes of Capsulitis
02:10 Symptoms of Capsulitis
02:33 Diagnosing Capsulitis
02:50 Treatment of Capsulitis
03:35 Using Custom Orthotics to treat Capsulitis
03:50 Using Shockwave Therapy to treat Capsulitis
05:02 How to connect with Houston podiatrist Dr. Andrew Schneider

[@dianeash2600]

I LOVE this!!!! SO simple. He talks slowly and clearly, explains things very simply and leaves you feeling educated and therefore back in control with all the mysteries blown away. Additionally, there are several ways to address this situation and that's great. Thank you for doing this educational video - very helpful!!⭐⭐⭐⭐

[@beckykendall7576]

Thank you so much! I was a very active person but I've been dealing with debilitating foot pain for almost a year. I told several doctors, including 3 podiatrists, that I felt like I was walking on rocks- painful pressure under the ball of my foot. xrays, mris, physical therapy, steroids, and orthotics. No one could figure it out and kept blaming the shape of my foot. Today, a new orthopedic doctor diagnosed me with capsulitis. I came here to learn more about it. It is so validating to hear you describe it as feeling like you're walking on a pebble. I wish a doctor would have recognized what I was talking about 11 months ago when I first started hurting!!

[@kazwilsy2408]

Thanks yes sounds like what I have. I wear orthotics already and have recently had them adjusted with an extra high point under the ball to help straighten some hammer toes but it seems to have also made this 2nd toe worse...its bent at 2nd joint others at 1st joints and big toe has small bunion forming. Not had pain free for awhile.

[@ramyaneelakandan3621]

Hi dr! Wonderful video , I was diagnosed with second toe capsulitis.Great info

[@DrAndrewSchneider]

Thanks for the kind words and thanks for watching. I hope your capsulitis is under control.

[@roxxagape5835]

What did you do to relieve the pain?

[@elsaheredia3520]

Your awesome 😎 thanks for this very thorough video 😀

[@rowbear]

Thank-you, it may prove quite useful.

[@DrAndrewSchneider]

I’m glad. Thanks for watching.

[@isaiahphelps1573]

Thank you this helps so much

[@DrAndrewSchneider]

I'm so happy it helpful! Thanks for watching!

[@comcfi]

Can this condition be caused by running?

[@SephirothXValentine]

At this point I have a bump on the top of my foot along the path my big toe travels up my foot which i can only assume is a bone spur just due to the progressing pain i get throughout the day. My second toe just sits separate from all toes while in it's position of comfort, whereas on my unaffected foot all of my little toes chill together, and it's usually where my walking pain begins after a few hours. Flexing the toe is painful and the ball underneath it is typically tender, I attempt massaging it and then give it a slight pull and sometimes it will trigger a pop like you'd get from popping any other joint. Massaging it more could lead to more joint pops. It's weird....
One other thing i've noticed on my affected foot is the skin is tighter on the bottom closer to the heel.
Definitely going to try some anti inflammatory meds, see if that makes a difference. If not going to try taping. thanks for the video mate.

[@sanja12]

what is the difference between Capsulitis in the Second Toe and Freiberg’s infarction ?

[@Stormin_Norman]

I'm dealing with this right now in both feet, not fun at all.

[@kippyc98]

Is there such a thing as Capsulitis of the 3rd toe?

[@jasonstone5022]

Is there a general consensus for healing time? I’ve had this since the Fall and it’s awful. Met pads don’t seem to be working well. Nor do orthotics.

[@drojohnson4256]

Any updates?

[@crispycruiser4654]

@@drojohnson4256 Nope. No one ever comes back to update and help someone else. Either he's still suffering with it, or he had surgery and is feeling better, but they never reply to TH-cam comments.

[@thangaduraimakisha1995]

Hi sir. Same problem second toe bone cracked. Toe is fine. But long time standing leg and hip pain. Solution plsss.....

[@DrAndrewSchneider]

Consider a custom orthotic to reposition the foot to a more stable position. Should take the pressure off of your hips and legs and resolve the pain.

[@yasirarfat737]

Hi, I am from Pakistan and want to take help for my mother . Issue is that there is a hard ring like rubber on the upper side of middle finger of feet. If you solve it, I shall be thankful to you. My mother my life. Thanks sir

[@DrAndrewSchneider]

That sounds like a corn on top of the toe. Use a coarse pumice stone every day. Just 4-5 rubs each day during or after a shower. Then it will slowly resolve.

[@Minnie_Robbie]

Wow. Too bad I didn’t see this video years ago.

[@DrAndrewSchneider]

Glad you saw it now though! Thanks for watching!