Capsulitis of the second toe and the second MTP joint is one of the more common conditions that we see and treat.  Much of this problem is mechanical in nature.  Some it has to do with the foot structure itself and it can also be an overuse injury.  There is essentially too large a stress load going to this one joint (2nd MTP) disproportionate to the adjacent joints.  The traditional treatments that are still critically important include prescription orthotics and good shoes that have forefoot rocker such as a Hoka shoe or Altra shoe.  Other treatments include stretching the calf with a night splint and there are other treatments such as taping.  

This can be a chronic and frustrating condition to treat.  For the most intense problems where there is inflammation of the capsule we often consider adjunctive treatments.  One of the simplest treatments that can be done that does not involve an injection is shockwave therapy.  The goal of the shockwave therapy is to do intense treatment and the body essentially receives this treatment and believes there has been more trauma.  The body reacts by increasing the blood flow to the local tissues including the capsule.  

Also some the local healing factors, become more available to this tissue.  This is very similar in some ways to other treatments that help the body regenerate.  There are other treatments that can be done such as injections.  Injections of Supartz which is sympathetic joint lubricant can be very helpful especially if some of the problem is actually intra-articular and not just the capsule but inflammation and pain of the actual joint itself including cartilage pathology and degenerative joint disease.  Other injections may include Traumeel which is a non-cortisone based anti-inflammatory.  In severe cases the plantar plate can be damaged an MRI may be indicated.  These cases often require surgical repair.

 

Recently I had capsulitis of the second toe myself.  I already have and use hoka shoes and prescription  orthotics.  I did use a night splint and did aggressive calf stretching.  But despite this I continued to have symptoms and problems and I had to hold off on exercise–jogging.  So I finally had treatment with shockwave therapy, and that is what made the difference.  Within a matter of weeks I had excellent improvement such that I could resume running and jogging for exercise.