Capsulitis of the Second Toe / Crossover Toe

A capsule is a group of supporting ligaments that surround the joint at the base of the toe. The capsule aids the joint to function properly. But supporting ligaments may become inflamed in which case capsulitis occurs. Otherwise known as predislocation syndrome, capsulitis can affect any age group.

Capsulitis is most commonly seen in the second toe, but may also occur in the joints of the third and fourth toes. Patients often experience a considerable amount of discomfort with inflammation. If left untreated, this inflammation may cause the surrounding ligaments to weaken over time, resulting in dislocation of the toe.  

Some structural abnormalities in the foot can cause patients to bear more pressure on the ball of the foot when walking. These structural abnormalities often include severely deformed bunion (s), a short big toe as compared to the second toe, a tight calf muscle, and a structurally unstable arch.

Seeking treatment when symptoms are first noticed is crucial in preventing capsulitis of the second toe from becoming more severe over time. Initial symptoms include:

Surrounding ligaments eventually weaken in the advanced stages of capsulitis and fail to stabilize the joint of the affected toe. The end result is “crossover toe,” in which the weakened toe moves toward the big toe, crosses over and ultimately lies on top of the big toe. The accompanying symptoms in this final stage are the same as previous stages. “Crossover toe” normally occurs gradually, but may result more rapidly from injury or overuse.

Patients should consult Dr. Radovic for an accurate diagnosis because the symptoms of capsulitis resemble those of Morton’s neuroma, but the two conditions require different treatments.

To diagnose capsulitis, Dr. Radovic will examine, apply pressure to, and maneuver the foot to reproduce symptoms. The joint will be tested for stability, and inspected for possible causes of capsulitis. X-rays are normally ordered, but in some cases, advanced imaging studies may be needed to confirm diagnosis.

Early treatment of capsulitis is crucial in preventing the second toe from moving toward the big toe. Non-surgical treatments can effectively stabilize the joint, reduce symptoms and address underlying factors of capsulitis in early stages.

Dr. Radovic may choose one or more of these early treatment options:

Rest and ice. Resting the foot and applying ice therapy helps relieve pain and swelling. Always place a thin cloth between the ice pack and the skin to avoid skin damage. Apply ice for 20 minutes, then allow the area to warm for about 40 minutes before using ice again.

Oral medications. Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) help reduce pain and inflammation.

Taping/splinting. Immobilizing the toe with tape helps reduce pain and prevents further movement of the toe.

Stretching. Stretching exercises for tight calf muscles may relieve pressure from the ball of the foot.

Shoe modifications. Supportive shoes with rigid soles help control motion, and reduce pressure from the ball of the foot.  

Orthotic devices. Custom orthotic devices effectively distribute weight away from the joint. Dr. Radovic may include arch supports or a metatarsal pad to maximize the effectiveness of this treatment.

The second toe cannot return to its normal position once it begins drifting toward the big toe, unless surgically corrected. Dr. Radovic will recommend the most suitable procedure or procedures for each patient. 

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