Joints are amazing, complicated constructions. Bones, muscles, ligaments, tendons, fluid-filled bursa sacs, and more must work together in perfect harmony to enable the joint to move smoothly, safely, and correctly.

Many joints, including the one at the base of your toes, feature something called a “joint capsule.” These capsules are composed of ligaments that surround the joint and keep the bones properly aligned, allowing them to function properly along their intended range of motion.


Ligaments are like leather, and while they’re tough, they aren’t as strong as bone. They can get inflamed, torn, or damaged. This is called capsulitis, and it’s especially common for the joint capsule at the base of the second toe.

Capsulitis in the Early Stages

Capsulitis is a progressive condition, which means that it usually does not get better on its own and symptoms gradually worsen without treatment. That’s why it’s important to identify the symptoms in the early stages.

The most obvious early warning signs are pain and swelling in the ball of the foot, particularly around the base of the second toe. It may feel like you’re standing on a marble or rock, and you may find it difficult to walk barefoot or fit into a pair of shoes without pain or difficulty.

End-Stage Capsulitis

As the capsular ligaments continue to weaken, they slowly lose the ability to keep the bones aligned. The now-unstable big toe begins to drift, eventually crossing overtop the big toe. Once this happens, the only way to reposition it.

Causes and Risk Factors of Second Toe Capsulitis

Although technically you can get capsulitis in your third or fourth toes (along with some other joints, such as your shoulder), the second toe is by far the most common due to its length. In fact, people with second toes longer than their big toes are at increased risk.

Most cases of capsulitis can be traced to repetitive trauma or constant pressure at the base of the toes. Activities with lots of stooping or toe bending (gardening, climbing ladders, electrical work, playing sports with lots of running) are associated with increased risk. Shoe choice can also make a difference high heels, flimsy flats, or even frequent barefoot walking can lead to excessive toe bending, overstretching and damaging the capsular ligaments.

Treatment for Capsulitis

If detected early—before the toe begins to cross over its neighbor—it is likely that conservative approaches will be able to adequately stabilize your joint and adequately address your discomfort. To control pain and swelling, we usually recommend you try to stay off your feet as much as possible and use ice wrapped in a thin towel (no more than 20 minutes at a time, once per hour) and/or OTC anti-inflammatories such as ibuprofen.

Splints or “buddy taping” procedures may be necessary to keep the toe stabilized in the correct position and prevent permanent drifting, while certain stretches and physical therapy practices can help you strengthen the supporting soft tissues and relieve tight muscles that may be pulling on the capsule.

The most effective treatment in many cases may be a combination of selecting appropriate shoes and using inserts such as custom orthotics. Shoes with stiff soles reduce flexing and pressure on the ball of your foot, while orthotics can provide arch supports, extra padding, or other aids to help redistribute weight away from trouble zones and keep you cushioned.

If the toe begins crossing over, or conservative options fail to deliver the necessarily relief, corrective surgery will be considered. Procedures vary depending on your individual situation, needs, and lifestyle goals.

The important thing to remember, in any case, is that the sooner you call for help, the more successful simple treatment methods are likely to be. Don’t wait until surgery is the only choice! If the base of your second toe is hurting, call Dr. Keith McSpadden at North Austin Foot & Ankle Institute for a checkup and see what treatment options may be right for you. You can reach us at 512-593-2949, and you can also request an appointment online.