String tied around toes
by Ernie
(Granger, Indiana)
capsulitis of second and third toes
About six or seven years ago I started to get the feeling as if a string were tied around the 2nd and 3rd toes of the left foot. It is not particularly painful, just irritating. It is not turning color, does not feel numb but it does feel somewhat different than the other toes although I would be hard pressed to describe the feeling. I spent a lot of time on my feet at work and drove a manual shift car for many years (clutch), so I thought that may have had something to do with it. After a year or two of it not going away I saw a podiatrist and he said something about a ligament that holds the toes together laterally, and gave me an insert to put in my shoe (went under the ball of the foot). After wearing it for six months with no improvement I returned to see him and he gave me a slightly different insert which again did not seem to help. Recently I noticed the same feeling in the same area of the RIGHT foot. I read about capsulitis and neuroma but they do not seem to be the same thing. I see a lot of hits on the internet of people with "string tied around toes" syndrome but no diagnosis or solutions. Any ideas?
RESPONSEHi Ernie,
I have been a podiatrist for a very long period of time and cannot recall ever having someone describe their toes as if there were a string tied around them, but that's just me.
Based on your description it sounds like this sensation is occurring at the base of each toe. I say that because the podiatrist you saw gave you two different inserts, one at least was supposed to raise the ball of your foot. I therefore, assume the insert had a metatarsal pad built into it which would be used for capsulitis or possibly a neuroma.
Since the podiatrist mentioned a ligament he probably had a working diagnosis of capsulitis as that is an inflammation of the ligament that actually holds the toe bone to the metatarsal bone behind it. There really is not a ligament that holds each toe together with the adjacent toe. If you look at the enclosed diagram the red arrows are pointing to the capsular ligament of the second and third toes. If they are both inflamed then you could have the sensation that you describe, assuming this string is occurring at the base of your toes.
Assuming your circulation is fine going into your toes and I assume it has been checked, then the two most probable causes of your sensation would be either capsulitis or neuroma.
In
these instances both conditions cause inflammation at the base of the toes. I would assume that might be what is giving you the sensation of a string tied around your toes. Many people also describe the sensation as if their sock is rolled up underneath their foot.
Certainly driving a clutch could set this off on your left foot. The reason I know this is that I had a clutch on my last car and started suffering from capsulitis. Once I got rid of the car, the capsulitis went away.
Now I realize this is more of an annoyance than a crippling problem but obviously you are interested in getting rid of the pain.
Usually an insert with a metatarsal pad can be helpful assuming the metatarsal pad is properly placed. You did not mention if these inserts were custom made or just an insert that was pulled off the "rack".
At this juncture you might want to consider a cortisone injection or even a round of anti-inflammatory medication (if you can tolerate such medication) for perhaps two to three weeks in an effort to reduce the inflammation.
I would be remiss if I did not mention that a lesser possibility might be an actual growth of some sort in the area of discomfort. A growth like a ganglion cyst or bursitis that could be possibly growing in the area may also give you the same sensation.
The fact that you are starting to have this same type of problem on the right foot would lead me to believe there probably is not a growth but if treatment fails to alleviate the problem on your left foot then an MRI might be indicated.
Additionally, since you are beginning to experience the same problem on the right foot, the next thing I would look at are the shoes that you wear, as that is usually the common denominator when there is bilateral foot pain of a similar nature.
Two types of shoes that can aggravate capsulitis or even neuroma would be very flexible shoes like flip flops, boat shoes and any shoe for that matter that has a lot of "bend" in the forefoot. In other words, a more rigid shoe like a well made dress shoe or a good athletic walking shoe would probably be more helpful.
Activities such as ladder climbing, stooping down as in gardening or carpentry work, a lot of stair climbing without shoes can also set off capsulitis.
My suggestion would be to first think about the shoes you wear, the activities you perform and make any changes, if possible, then go back to your podiatrist and inquire about oral anti-inflammatory medication or perhaps a cortisone injection.
Marc Mitnick DPM
DISCLAIMER
