Dr. Timothy Young a Board Certified Foot Surgeon, Talks About Surgical Treatment of Capsulitis of the Second Toe and a Bunion Deformity Combined

Surgical treatment for this condition involves correction of the bunion deformity, which often helps the second MTP joint capsulitis. The ideal procedure for this would be fusion of the first metatarsal-cuneiform joint in combination with the bunionectomy (lapidus bunionectomy or lapiplasty). The fusion of the first metatarsal stabilizes the first metatarsal and therefore able to bear the weight that it should be proportional to the rest of the foot.  Therefor this procedure takes some of the stress off of the next in line 2nd metatarsal.  So a lapidus bunionectomy is often a very effective treatment for both the bunion and capsulitis of the 2nd toe.

 

Sometimes the Lapidus Bunionectomy is not enough to correct or adequately deal with the second MTP joint stress load.  This is especially seen if there’s a very long second metatarsal or short first metatarsal.  In this case, the second metatarsal can be shortened for example with a weil osteotomy.  In addition if there’s a hammer toe of the second digit, this should be corrected at the same time.  If there is 2nd toe plantar plate damage, then it can be surgically repaired or a flexor tendon transfer of the second toe is often benefitial.

 

The xrays below show a lapidus bunion repair and a weil osteotomy to shorten the 2nd metatarsal.