Today I want to talk about pain in and under the second toe.
Now the second toe lives a very, very rough life.
It has more force put on it than any of the other toes.
So it's much more likely to get injured and much more likely to be painful.
This is due simply to the way that most feet function.
So if you look at a normal human step, most of us hit on the outside of our heel, we go
forward, big toe joint bends, and we come off the ground.
Now some people roll in too much or over-pronate, and when that occurs, the ground presses up
under this big, first metatarsal bone.
Now if you look at the bottom of the foot, this first metatarsal is the biggest of any
of the metatarsals, and it should take up about half the weight of the ball of the foot.
But in someone who pronates or rolls in too much, the ground pushes up under this area,
and this actually, this bone actually has its own independent range of motion.
So it's pushed up out of the way, and it no longer bears as much weight as it should.
That leaves this little second metatarsal bone taking up a lot of extra force.
And so you end up getting excessive pressure under there that leads to a lot of different
problems.
Number one is just inflammation in this area.
So a lot of people who roll in too much or maybe have bunions, they're not bearing enough
weight on that first metatarsal, and if you press up under this area it will be painful.
What that is is an inflammation of the joint, or actually the ligaments that make up the
joint.
They are called the capsule of the joint, and you can see what that looks like over
here.
This is a different joint, but that's what that capsule looks like.
It's a tight array of ligaments that make up that joint.
And that capsule can be irritated, and that is a condition called capsulitis.
Now if you have capsulitis, our primary goal is to transfer pressure off of this area.
So we might use an over the counter arch support.
And if you go on our website and do a search for capsulitis or a condition called metatarsalgia,
which just means pain under the ball of the foot, you can find a list of good over the
counter supports that you can put into your shoes that'll get pressure off of this area
quite effectively.
Now if that's not enough, we can make you a custom orthotics.
Custom orthotics work better for this condition because they grab the arch tighter through
here, and they transfer pressure more effectively off the ball of the foot.
Now make sure you go to someone that really knows what they're doing.
I see a lot of orthotics made that are just not high enough to get pressure off of that
second metatarsal joint.
And it's just a real problem in the industry that these orthotics are not always made the
way they should be.
Couple of other conditions that can cause pain in this area.
If you have pain in this region that has not responded to standard treatment, that's sometimes
because there's been a tear of the capsule of the joint.
There's a portion on the very bottom of this toe, on the joint that's called the plantar
plate.
And that essentially a thickened portion of the capsule.
Now that can actually get a tear in it, particularly if there's either long-term pressure on the
area or an injury that brings your toe up like that, it can tear that region.
And that often, what we'll see in that situation is people that just don't get better.
They don't respond to standard treatment such as orthotics, or shoes like this that have
a rocker sole on them that will rock through the step and take pressure off that area.
Sometimes we need to immobilize this for a while.
If you're just not getting better, we may need to do some more involved imaging.
Obviously we would have already have gotten X-rays on the area.
But if you're just not getting better, we may do a test called an arthrogram MRI where
a little bit of a dye is put into this joint, and then an MRI is done.
And you look and see does the dye leak out.
That dye should not leak out.
And if it does, then it's an indication there's a tear on that joint.
So if you're someone who's had a lot of pain affecting the second toe, there are a number
of different reasons why that can occur.
First of all, if you have questions on this, if you go to our website and just do a search
for second toe pain you'll find a lot of information there.
If you're in our area, make an appointment to come in and see us.
If you wear orthotics or arch supports, be sure to bring those with you.
If you're not in our area, find a podiatrist that specializes in biomechanics and orthotic
therapy.
They're the ones that are most likely going to be able to help you take care of this problem
in a conservative manner and not rush into surgery.
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