• TODO: Blood sugar measurements
• Left foot often feels colder to the touch than the right.
• Vascular problem? Left foot is noticeably darker than my right.

Things to Try

Taping the Second Toe

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Cutting a Hole in Orthotics

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Sandals

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Slippers

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Cortisone Injection

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Orthotics

Orthotic Cutouts Toe Floats

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Orthotic Cutouts Toe & Metatarsal Floats

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Orthotic Cutouts Metatarsal Floats

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Treatment

Capsulitis

• Capsulitis is tricky because there are usually 2 aspects to deal with to recover.

Part 1

Part 1 is making the toe feel nicer again, which usually requires re-learning how to contract the tissue under the 2nd toe which moves it into flexion without curling, and then having it move up/down through its expected range of motion.

Rest, shots, orthotics etc will probably not do anything towards regaining this skill, as it requires an exercise with a specific setup and intent to do so - and those other inputs are trying to do that.

Part 2

Part 2 is figuring out why that toe got overloaded in the first place, and adapting that to prevent the problem from recurring. This is usually something that prevents the foot from loading fully side to side - so the first places I'd assess for are heel inversion/eversion, big toe flexion/extension, and hip rotation.

In every case I've seen, one or more of those really stand out as movements that can't be expressed very well, and would be the root cause.

I'd say that getting the toe to learn flexion again + altering the root cause to work a little differently are the most reliable ways forward. Anything else is just accommodating around the problem, and while your body may find some equilibrium in time, its not a fast or reliable plan.

Hi!

I have this same problem in my second toe. Although, not as bad as OP. But I’d also like to correct it.

My foot definitely cannot load fully from side to side! It feels like my body has adapted to putting most of my weight on the outside of my foot.

What are some exercises you would recommend to address the roots causes you mentioned?

Its a little different for each person, but as a general thing for what you describe I'd suggest

that you want to try and get your heel moving side to side like this a couple mins each day, as long as it feels ok: https://www.youtube.com/watch?v=P6C7Un_Eopg

And in particular feeling effort on the sides of the calf. Outside of the calf to move the heel away which will help encourage loading towards the big toe side of the foot, and inside of the calf to move the heel in to load the outside edge of the foot

2. get a better sense of the outside of the calf with some ankle eversion isometrics - again, as long as they feel ok: https://www.youtube.com/watch?v=1o4smN_b3T0

As you feel more of the outside of the ankle, you'd want to twist/lift the heel in such a way to feel more sensation in the calf than the shin. Use soft intensity, and note that it will often cramp when trying to contract muscles like this which may not have been used in awhile.

Let me know if you have any more questions or feedback and I can try to help further!

Thank you so much for your detailed response. I was pretty immobile for a few years(depression not physical ailment), but in the last 10-12 months I’ve been slowly ramping up my exercise to get in better shape/improve my mood. I’m up to about 2 miles running 4-5 times a week, and I noticed a sharp pain developing under my second toe’s knuckle(ball of foot area). Luckily I came across this thread! My second toes have always been a little longer than my first, especially on my left side where the knuckle pain has started. I’ve began doing the exercises in the videos you posted and at night they give me a lot of relief. Is there anything else I should be doing? I know everyone is different, but does the problem I described seem similar to the previous posts?

A little further info I forgot to mention. Due to a lifelong circulation issue, I had began to wear compression socks a lot during the day. They actually helped ease the ankle/Achilles/calf soreness I would have early on getting back into exercising regularly. But I worry that maybe the pressure/constrain on my second toe is making it curl more, causing this issue? Last note, the my pinky toes in my family all curl almost sideways, and now that I write all these things down it’s kindve a miracle I’ve been able to get in better shape at all haha but if any of these things stand out or if there are any other exercises/things I can do, I would really appreciate your advice. Those videos made a lot of sense to me, and your advice seems very thoughtful, thank you for all the help you’ve given everyone here.

There are too many options to know without evaluating.

In general we want to move load across the foot from side to side, which involves hip external rotation into hip internal rotation, same with the knee, and the ankle moving from inversion to eversion, and the big toe moving from flexed to extended.

Each one of those positions can be judged on its own merits as well as its ability to move into the next position - and then prioritizing and programming on top of that as well.

My best suggestion is to figure out which of those positions are more/less easy to get into for you, and focus on the ones that seem more challenging.

Thank you so much for your reply, I can’t tell you how much I appreciate it. Do you know of any good YouTube videos that show how to do the hip/knee/ankle rotation tests? Or moving the big toe from flexed to extended? I’m sorry if these aren’t the right questions, I’m very new to all of this and don’t have a great handle on the correct vernacular/lingo yet. Even if I don’t hear back, you’ve already been so helpful to myself and many others, thank you 🙏

There are a wide variety of things to check for in each place, for example on my site I have 16 videos to self-assess just the ankle....along with programming to try and match what to do with what that joints status might be. (as well as getting started generally with a mobility routine)

In that regard, I provide some broad info to help people think about things in a new way - but a fuller assessment and programming is only available with a paid subscription to my site, and/or if you wanted to setup a personalized consult.

That being said - here's one really broad way to understand some basic elements of hip rotation: https://www.articular.health/posts/hip-rotation-kneelow-back-compensations-that-happen-if-you-cant-express-it

And to see if you can control heel movement into/out of eversion and inversion: https://www.articular.health/posts/looking-for-heel-shift-with-ankle-capsule-cars

And one way to see if you can feel/use one of the intrinsic big toe flexors: https://www.youtube.com/watch?v=STeMnFLrvYE

And lastly one way to generally observe your big toe extension: https://www.articular.health/posts/sample-assessment-big-toe-extension-basics-1-of-4

Unfortunately we can't get more specific on what to focus on first, and what to target to change initially, without assessing things in some detail. And that is quite challenging to do without some training for these things - although for some people with high body awareness it can be possible but not quick.

I hope that helps with some ideas, but let me know if you have any questions and I can try to help.

I'm trying to figure out if i have capsulitis because the onset of symptoms have been very strange. First, i felt like the top side of my second toe was sore and slightly painful. A few days later, the tip began to feel bothersome. The next day, the backside of my toe started hurting right where my toe meets my foot. It feels uncomfortable to walk because of the contact between the joint and the shoe/floor. However, the ball of my foot is normal and there is no swelling or pain. I know something is wrong but i read everywhere that the main issue with capsulitis is pain in the ball of foot. Should I wait it out a bit longer? I've been stretching my calves, icing my toes, and resting. Is there a way I can test myself for capsulitis?

Hi, I've been struggling with this for almost a year now and have found your advice VERY helpful, so thank you. I have a much longer second toe, and i've been working on my hip internal rotation, big toe and ankle mobility every day. I'm wondering what exercises you suggest for toe flexion (what you mention in part one). Is there a way to isolate the second toe and teach it flexion without curling?

I’m sorry to hear things are not working to heal your foot. I too have been suffering from toe capsulitis for 10 months. It started with an injury in my left foot from running into my dog, so dumb! I was diagnosed with Morton’s Neuroma after an MRI. I limped for months while seeking treatment which involved wearing Hokas and getting 4 cortisone shots. In the meantime I developed pain in my right foot metatarsals from compensating for the pain and therefore putting too much pressure on my right foot which was later diagnosed as toe capsulitis. I have tried custom orthotics, prednisone, more cortisone injections, metatarsal pads, icing, contrast baths, epsom salt soaks, wearing a medical boot, loads of ibuprofen, hammertoe pads, stretching my calf muscles, elevating my feet, physical therapy toe stretches, resting, turmeric, tart cherry juice, ultrasound therapy, and nothing has helped. I completely understand your frustration! I too am desperately seeking healing and appreciate any advice.

Thread 2

I also found that a lack of internal hip rotation prevented my big toe from reaching the ground easily as my leg passed underneath me - additionally overloading the 2nd toe.

In addition to the suggestions in the video, I would encourage anyone with discomfort in this area to look into the rotation they are able to utilize in gait. Primarily that would be hip internal and external rotation, but also how much the ankle can move side to side.

Some feet and legs may benefit as well from incrementally acquiring controlled movement at the midfoot from supination into pronation, and ensuring you have control over tibia rotation as well.

Assuming your right big toe doesn't tend to reach the ground during your hair cycle, what exercises would you recommend to help fix form?

It depends on why thats the case - there are likely several factors and maybe 1 being primary.

Usually I'd say it could be things like the hip doesn't internally rotate enough, or the ankle or heel doesn't evert, or the midfoot doesn't move down enough, or that the big toe can't really take that load so everything is working to help stop that from happening.

Do you have any suggestions or videos on how to improve internal rotation?

What is proper footwear? I've been spending hundrends of dollars on running shies and the all make my metatarsals hurt!

Proper footwear is different for everyone. Mostly, its whatever is comfy at first, and then also something slightly more challenging in small doses if they are working towards some changes as well.

Without assessing it can be hard to know, but for metatarsal discomfort I'd usually suggest stiffer soled shoes or insoles to help keep things from move into a problem position.

But, for some of these situations its the fact of bearing load that is the problem, not a particular movement - so it can be key to understand where movement is not tolerated, and begin some process to restore tolerance and then some control over the movements which may not be accessible today.

Shoes can never be magic, and while sometimes they can help accommodate a problem to make it feel better - its always going to be higher value to also add abilities to the foot that they can't demonstrate. And sometimes, its required to do so, if no shoes can be found which allow for the desired comfort.

I get the pain below the second toe shown in the video especially during wearing my barefoot shoes. Essentially it feels like the bone is hitting the ground and taking all the weight. Anyone else?

Thats exactly what it felt like for me - in my case it was an inability to load the big toe sufficiently so the 2nd toe ended up taking too much load it isn't designed for.

Its the type of problem that doesn't tend to go away over time, or be something you can build up strength for.

I'd highly recommend keeping that inflammation down, as it can progress to a more entrenched status and get more painful.

The answer is usually going to revolve around finding whats stopping you from loading the full width of the foot, and is going to probably involve some aspect of hip rotation, ankle/heel eversion/inversion, or ability for the big toe to flex/extend.

Figuring out which of those can least express itself is probably a good first step - as then you'll have something you can focus on adapting.

Finding your comments on what has been a mystery to me for a few weeks now is like finding an illuminating light. I even went to a primary care doctor for it last week and he just sent me for an X-ray which of course came back showing nothing. Like how you mentioned hip rotation or ankle/heel eversion/inversion, I think mine could be a problem related to my gait and footwear (raised heel, spring toe, and toe tapering) like that was mentioned in the video you posted. I've saved your comment/post to bring up during a follow-up with my doctor. Do you think I should push for a podiatrist or orthopedic specialist referral? Or maybe once I present my doctor with these findings he'll have a better direction in mind that just x-ray.

Nice! I'm glad you could find some info to relate to.

Its always ok to share more info and have a conversation with your providers, but in that context it may only be helpful as a diagnostic label.

That's a good thing to have, but getting that on point won't typically help with the story of how its come to be, or what to program to change it.

In my experience it takes a detailed articular assessment to figure those things out, and across all the people I've worked with I've never met anyone who's had that experience with a clinical provider. Instead you'll find that there are attempts to accommodate around the problem, provide a lot of details on the current status of things, efforts to generally strengthen the foot etc - but virtually no information what each of the relevant joints involved can actually do, or not do, on a very specific basis.

That is to say, does the hip and ankle rotate sufficiently, and does the big toe and small toes flex/extend enough? And where are those articulations controlled from, and what is their active/passive ratios, and do they have any closing side problems? These are the factors that I've found most crucial to unwinding this sort of thing, yet they tend to be completely ignored by most - primarily I think because they've simply never been trained on the concepts.

To solve for something like capsulitis takes 3 steps:

find ways to accommodate around it to avoid inflaming it, and managing the inflammation when it does happen. Most clinical providers will likely have ways to help with this, though it may be a bit of trial/error to figure out what works best for you.

figure out whats not happening well enough (usually a long term thing) which is creating the context in the first place. Typically that will be something in the hip, ankle or big toe which prevents the foot from being fully loaded across the width during gait. (check the stickied post on this forum for some info about why those factors are key. Once thats understood, you can begin to make a bit of effort to add back whats missing.

get the involved toe to learn how to flex and extend enough again, and control itself through that range of motion. Usually the middle toes tend to all move together, so if you have a problem in one, the other toes sort of move it around and it can all seem ok at a glance, but this step really requires getting granular with the problem joint, and making small shifts in its local ability over a decent amount of time. Its subtle work, and no amount of "general foot training" or strengthening will ever be targeted enough to alter how one particular metatarsal head joint can express movement. Being very specific with what you're doing is key.

I hope that helps with some ideas - but let me know if any questions and I can try to help further.

I have been dealing with capsulitis of the second metatarsal phalangeal joint on my right foot for a few years. I am a runner (only a few miles a week)

Only within the last few months did I come to self-diagnose and begin to take the right measures to heal. the first thing I did was discontinued running and switch to cycling for my cardio.

After experimenting with various options, I have been wearing Keen sandals with a TPU 3D printed orthotic insole I made myself, that has 2 mm thicker support under every metatarsal head except the second one (relieving pressure) and about 2.5mm of added support directly behind the ball of the foot, increasing the already good arch support of the sandals. after only a couple of weeks I am discomfort and pain free.

I have made various other versions of the insole for other shoes I wear, like my motorcycle boots.

I also experimented with barefoot style shoes, which have brought a lot of strength to my feet, but ultimately also further increased inflammation.

It seems the features of the Keen sandals that help me are the relatively low (albeit non-zero) drop, the very wide toe box, the lack of toe spring, good arch support and especially the fact that the soles are semi-rigid so that I don't flex the forefoot with each step. I plan on returning to barefoot style shoes (lems) after a few weeks of healing for short periods of time to see how it responds and provide more opportunity for building strength.

Nice, could you send a pic of that insole? I'm curious what its like and had considered trying to develop one for myself awhile back.

I would say that all that would help take some load off the area, and help make it less inflamed - but that for me, such changes were not "healing" in any way. As soon as I increased activity, the problem recurred. In my case this was due to dysfunction at the joint itself, caused by problems in my gait, and rest made it feel better, it was not doing anything to improve the way it worked.

At the same time you're giving a little room for the 2nd toe joint, one thing that helped for me was to begin teaching the big toe to take the load its meant to. Just putting some material under the ball of the big toe each morning while doing toe CARs/toe yoga was really useful for me - and then as that big toe became better able to feel it, I could decrease the height of the material, and start feeling the big toe ball of foot finding the ground more often when walking. A couple mins a day of something like that can really add up.

Another good one for me was to begin gently moving the toes into flexion, and learning how to hold the toes in that position. (which can often be a little crampy at first, but once you work through that the joint ends up with a bit more range of control).

In general I'd say a combination of improving active control of the foot/arch - in particular the big toe - along with managing your activity level will bring better results than rest and general exercise themselves. Identifying whats happening in your foot/gait to cause the extra load at that location is a good first step to long term resolution, anything else will tend to be accommodations towards whatever mechanics are producing the discomfort in the first place, without resolving the root cause.

I recently started paying more attention to how much weight I shift to my big toe for all the reasons you describe as well as exercising my arch muscle that pulls down the big toe. I believe for me what started this might have included a period when I had a plantar wart on the inside edge of the heel on this foot. Surely I must have been avoiding putting pressure on it (on the inside edge of the foot) and that might have led to this. I also have (or had!) a habit of running up every flight of stairs I had the chance to. I've discontinued that habit as I heal.

Here are some images of my design:

https://imgur.com/kZzELD8

https://imgur.com/FYmjz20

thanks for sharing those, nice work on getting those going!

I'd definitely think avoiding a part of your heel contributed.....it can be hard to get the big toe down properly if the arch, ankle and hip aren't fully allowing it, and sounds like you may have had a period where you encourage that specifically. Because of that, it may be worth trying to assess the side to side motion of your ankle, and get more familiar again with that full range of motion in case its not what it should be.

Here's one way to gently start exploring that: https://www.instagram.com/p/BsrCxaSBM9g/

And then that would be part of a fuller ankle movement: https://www.youtube.com/watch?v=1QPKpk8WC_I

Those could be worth doing a couple minutes each day, if you find that some aspect of your range of motion is more limited than it should be, there are related setups to make an improvement there specifically. If the rotation your leg is able to use in gait can increase, it makes it a lot easier to get the big toe in the position it should be to take its share of the load.

Sufficient hip, ankle and tibia rotation will be critical to let the foot operate in its expected position.

Did you get a numb big toe with this also?

What are the best shoes most I see with low heel have toe spring Any recommendations

Recently overcome L foot plantar fasciitis and the R foot achilles tendonitis. I'm not very active but this even limited my occasional long walks. Recent Xrays and u/S shows mild OA in big toes and mild swelling of mid-feet but no other issues such as fractures etc. However, my R second toe has started (couple of months now) to splay towards with big toe when I bear weight. Could this be capsulitis?? I have an upcoming tip to Eurpoe (read 'lots of walking') and I'm nervous about tolerating the pain and also for making things worse. I don't ever wear heels or pointy toes. I have pretty high arches and a wider foot. Generally wear Stan Smiths or Blundstones both of which have a pretty wide toe box and don't have much of a raised heel. I've recently purchased a slip -on metatarsal pad but it's not really offering any relief. Looking for thoughts and tips. Thanks!

You're a lifesaver. I have been with this pain for almost 1 and half years now. And this video explains the issue like no other. I'll ditch the running shoes for regular usage and see how that turns out to be.