Causes and risk factors
The main contributing factor for this condition is an abnormality in the mechanics of foot that causes an excess weight on the ball of the foot leading to irritation of the capsule. There are certain other contributing factors too which adds up to the causation. Bunions, tight muscles of the calf, imbalance between the extensors and the flexor muscles, and prolonged use of high heeled footwear are few common causes. In some cases, use of certain footwear which has elevated toe box or toe spring is another contributing factor for the same.
Clinical presentation:
Pain particularly at the ball of the second toe is the main characteristic feature. Dull aching pain is experienced which is aggravated by movement or pressure. Swelling is seen. Redness of the overlying skin occurs. Patient often comes up with complaints of sensation as if walking on stones. Difficulty in walking along with pain in the ball of the foot is commonly seen. Pain is especially experienced when the patient walks barefoot. Gradually, over time there occurs weakening of the ligaments which leads to instability of the joint of the second toe. In end stage of capsulitis, there occurs crossing of the second toe over the big toe.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the patient. A local examination is carried out. Certain tests are conducted by a surgeon in order to confirm the condition. A neurological evaluation along with x-ray of the affected foot can also be advised. Other imaging tests like CT scan can also be done.
Treatment:
The treatment plan consists of administration of medications like pain relievers for allaying the pain. In severe cases, corticosteroid injections are given. Application of ice packs will help to reduce the swelling. Modifications in shoes having stiff soles along with use of orthodontic devices in shoes is advised. In order to maintain the toe is proper position, taping or splint application is done. In cases where the conservative mode fails to relieve or improve the complaint, surgery is needed.
Other Modes of treatment:
Certain yoga exercises or physical exercises under a trained physiotherapist will help to strengthen the muscles and improve the flexibility.
Complications:
In long standing cases, formation of painful calluses are seen.
When to contact a doctor:
Seek an advice from an orthopedic doctor if one experience complaints of and swelling of the foot and or second toe.
System Involved: Musculoskeletal system.
Organ involved: foot, ankle, phalanges, bones, muscles, nerves, metatarsals, tarsals
