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Pain base of 2nd toe

by Steve
(Albany, NY, USA)

I'm 49. Over the past few years have occassionally experienced pain in the ball of my right foot while playing hard-court sports. Felt kind of like a bruise. It would generally go away on it's own with or without rest. 3 and 1/2 weeks ago, while coming to the end of a short sprint on a turf field, I took a long last stride and landed on my right foot. It was a normal landing with no usual twisting except that I felt a sharpish pain in the ball of my foot (around my 2nd toe).


Have continued being active presuming it would subside but it has steadily gotten worse to the point that walking directly on it is very painful. (I can walk on the rightish side of my foot without pain). By squeezing each joint between by thumb and index finger, I have found that the pain is isolated to the joint at the base of the 2nd toe (from a diagram of the foot bones, it is the joint between the Proximal phalanx and Second metatarsal). Applying finger pressure causes sharp but minimal pain. Having the weight of my body on it causes the most pain. In particular, going up on my toes is most painful to the point of being prohibitive. The pain feels more at the base/bottom of my foot than the top. There is swelling.

I just returned from an orthopedic surgeon who said there were no fractures on
the X-ray. He wants to do an MRI. He mentioned one possibility is a condition which he said particularly occurs at the head of this joint which I believe he
described as being a degenerative condition of the blood vessels. He gave it a
name which I believe had "syndrome" in it, but I cannot recall now.

The main purpose of this post is to try and find out what that "syndrome" might
be so that I can do some research. I would also be interested in any other
potential alternate diagnosis. I have confidence in this doctor and expect the
MRI to eventually yield the problem, just looking for more information so as to
be better informed.

One extra bit of background information which occurred to me is that my toes
(on both feet) have always felt a bit tight/inflexible. When stretched backwards, such as during a massage, the tendons always felt particulary tight
and uncomfortable. I wonder if the problem might be related to a badly strained
tendon or similar.

thanks in advance for any help/insight.


Hi Steve,

For anyone who treats foot problems on a regular basis, your thorough description of your symptoms is that of capsulitis. Had you not had an x-ray, I would have also considered a stress fracture, but since there is no fracture you are presenting with classic symptoms of capsulitis.
Your doctor is probably referring to Mortons syndrome which is basically a long second metatarsal bone relative to the first and third metatarsal which will cause pain exactly where you describe.
As far as I am concerned there is no need for an MRI right now. If the pain does not subside after it is treated as capsulitis, perhaps then an MRI.
Good luck.
Marc Mitnick DPM






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May 23, 2015
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capsulitis
by: Alice

I started with capsulitis about 2 weeks ago. Got out of bed one
morning and felt the pain at the base of the second toe on the
left foot. There is also a teeny swelling (smaller than a pea) and
it is tender to the touch. Thought it was a cyst and am waiting to
see what happens. In the mean time I have inserted "orthotonic"
pads into my shoes. These were made years ago by a podiatrist
for another problem I had back then, but I decided to wear them
for this capsulitis problem and I do find a great deal of relief.
Hardly am aware of anything wrong. As soon as I walk bare footed
I immediately feel pain, so I feel I'm on the right path, but don't
know if this will "cure" the problem permanently. I am surprised
when reading the comments on this ailment I don't read anything
about pad inserts except ONE person wrote about them
Hope my info will give you the desire to seek other options.

RESPONSE
For simple cases of capsulitis, a metatarsal pad added to an orthotic is the easiest way to remedy the problem.

Marc Mitnick DPM

Nov 09, 2013
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Thank you so much
by: Max

Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly. It all started for me after a severe hamstring pull last spring. Once I got my hamstring somewhat recovered I found that my knee and foot were having pain. I have since rehabbed my hamstring properly and both that pain and the knee pain are gone but the foot irritation is lingering. The diagram of the plantar ligament that is part of the capsular ligament is exactly where my 2nd toe pain and swelling arise. Some days are worse than others and mornings seem to be the worst. Now that I have a good idea of what I am dealing with I will apply some of the solutions found on these pages. I am very active with walking, jogging and other fitness activities and I can now see that I have most likely be in a cycle of constant aggravation of the ligament. This information has given me what I think I will need to rehab this ligament.

Jun 19, 2012
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Acute pain in 2nd toe left foot
by: Rose22

I have had this terrible pain in my toe for about 10 years or more. It starts in the afternoon and doesn't go away until morning or the following morning. I have to take 2 tylenol (sp?) with codine to make the pain bearable. I have had the bones and joint taken out of this toe and three other operations, but to no avail. This pain covers my whole toe and gets red and swells. I am currently taking 300 mg of Allopurinol tabs for gout, but that hasn't helped at all. I have been to 3 foot doctors, 2 ortheopedists, and I have all but given up. Does anyone have any ideas because I'm about ready to have the toe removed - but I really don't want too. Appreciate anyone's help.

RESPONSE

Without knowing more of a history on the toe it is difficult to offer any advice. Having said that, I will tell you that having multiple surgeries on the same toe, working in a small area like that, almost doomed you to having chronic pain.
Every time you had a procedure done, the body healed the area with scar tissue; that is normal healing. As you can imagine scar tissue is not like normal tissue. The resulting tissue is more rigid, less pliable and overall does not function like normal tissue. A given surgery will heal with some degree of scarring, some procedures more, some procedures less. It generally has to do with the amount of dissection and the way the surgeon handles the tissue, along with post-operative care and certain aspects of the individual in the way their body handles the healing process.
So, after multiple procedures on the same toe, it is not surprising that you may be worse off than you were when you started out.
The other problem that needs to be considered is whether or not your problem originally was a musculo-skeletal problem requiring work on the bones and joints.
Did any one ever rule out a neurological or vascular (circulation) origin for your pain?
Gout, should have been something that was ruled out years ago. You are probably on allopurinol now because the toe is red and swollen. Possibly gout, but more than likely, vascular compromise from all the surgery you have had. In general, gout does not get worse as the day progresses.
I do not have the luxury of examining you, but it sounds like you may be "stuck" with this problem based on my reasons above.
Before you would consider an amputation, some doctor should rule out vascular or neurological reasons why your toe may be hurting so much, because if one of those issues is your problem, you theoretically could end up with pain even after an amputation.

Marc Mitnick DPM
DISCLAIMER



Apr 24, 2012
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Pain in second toe
by: Anonymous

I too have pain at the base of my second toe and had a MRI. It is capsulitis and unfortunately both Orthopedists I saw had no treatment recommendation other than Voltaren Gel and advil. When asked about being active, they sort of left it up to me. How much did I want to deal with it once it was inflammed from being active? It hurts the worse when I walk barefoot in the house on hardwood floors. I feel the pain start to come on gradually and it intensifies until I can get ice on it for 30 minutes.
I think it is a matter of knowing what sets if off and wearing shoes that keep the joint from becoming inflammed in the first place. The custom made orthodics work great. It is afterwards that the pain comes on but ice can control it. I am just not always at a place where I can wrap the foot in ice. And so long fancy shoes.
Frustrating.

Sep 23, 2011
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Happy to find this post on first try
by: Robin

I am a Zumba Fitness instructor and I too have been having the problems you described to a tee only its on my left foot. I thought I needed new shoes and tried that a month ago. I helped a little but I still get pain off and on in the toes, mainly the base of my second toe. I have tried ice, heat, tiger balm, motrin. Sometimes I swear it is better and then other times its back. I have been afraid to go to the doctor because he will probably tell me to stay off it. I am very interested in how your MRI turns out. Thanks for the great description!

Nov 30, 2010
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Avascular necrosis
by: Shane

Or Frieberg's disease, sounds like what your doctor may have been describing and trying to rule out with the x-ray.

Mar 03, 2010
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Me Too
by: Scott

Hi Steve.
Reading your excellent description of your symptoms was like reading my own condition. I've been searching the internet for the last month in search of relief for my foot (2nd toe) pain. I am 51 and have been playing a lot more hard court volleyball this past year. My doctor told me I had stretched my tendon under the 2nd toe (makes sense). My chiropodist had 3/4 inserts made for me with a bump on top to apply pressure to my metatarsal arch. Neither of the doctors identified that I have Mortons Foot (syndrome), which I do.
A number of web-sites say that the inserts I was given will aggravate the undiagnosed Mortons toe. Sure enough my pain was increasing after a week. Dr Shulers website (whyyourfeethurt) explained Mortons toe to me for the first time. He basically promotes the idea that a 'shim' placed under an odor-eater at the point below the end of the 1st metatarsal will relieve the pressure 'next door' (under the 2nd joint). I have tried this for a few days, and so far, so good. The problem is that my foot is injured and I need to find a way for the tendons to return to normal as the 2nd toe sometimes dislocates while walking.
I am impressed with IndianaBrace's X1 insert. It is primarily for turf toe (usually the big toe), but indicates that it is good for Mortons toe as well.
Have you tried a rigid-type insert? How did you make out with the MRI & have you any tips that led to success?
Cheers, D. Scott Taylor

Apr 30, 2008
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Feedback to "Pain base of 2nd toe"
by: Steve

Dr. Mitnick,
This is in regards to your response to my post
"Pain base of 2nd toe"
(http://www.foot-pain-explained.com/pain-base-of-2nd-toe.html)

Thanks very much for your feedback. Based on my reading as a layman and my instincts, capsulitis seems like the most likely fit. I also came across your "turf toe" write-up
and even though that seems to apply to the big toe, the scenario and symptoms are very similar to my situation.

The problem seemed to have been getting slowly better in the past week after I suspended athletic activity. But then, yesterday, I was sitting at the table for about an hour with my feet angled back under me so that they were resting on my hyperflexed toes and when I got up it felt like I had gone back to square one. So, it seems to reinforce that the problem is caused/exacerbated by hyperextension of the tendons.

I had followed my Ortho's MRI recommendation before receiving your initial response, so I am currently waiting on MRI results which hopefully will resolve the issue. Once known, I'll post the final results for your interest.

In the meantime, I appreciate your taking the time to respond to my original post.

regards,
Steve

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