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What is Capsulitis of the Second Toe?
Ligaments surrounding the joint at the base of the second toe form a “capsule,” which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed.
Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis—also referred to as predislocation syndrome—is a common condition that can occur at any age.
It is generally believed that capsulitis of the second toe is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight-bearing pressure.
Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.
Because capsulitis of the second toe is a progressive disorder and usually worsens if left untreated, early recognition and treatment are important. In the earlier stages—the best time to seek treatment—the symptoms may include:
- Pain, particularly on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up
- Swelling in the area of pain, including the base of the toe
- Difficulty wearing shoes
- Pain when walking barefoot
In more advanced stages, the supportive ligaments weaken leading to failure of the joint to stabilize the toe. The unstable toe drifts toward the big toe and eventually crosses over and lies on top of the big toe—resulting in “crossover toe,” the end stage of capsulitis. The symptoms of crossover toe are the same as those experienced during the earlier stages. Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury or overuse.
An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton’s neuroma, which is treated differently from capsulitis.
In arriving at a diagnosis, the foot and ankle surgeon will examine the foot, press on it, and maneuver it to reproduce the symptoms. The surgeon will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies are sometimes needed.
The best time to treat capsulitis of the second toe is during the early stages, before the toe starts to drift toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms, and address the underlying cause of the condition.
The foot and ankle surgeon may select one or more of the following options for early treatment of capsulitis:
- Rest and ice. Staying off the foot and applying ice packs help reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
- Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
- Stretching. Stretching exercises may be prescribed for patients who have tight calf muscles.
- Shoe modifications. Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
- Orthotic devices. Custom shoe inserts are often very beneficial. These include arch supports or a metatarsal pad that distributes the weight away from the joint.
When is Surgery Needed?
Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The foot and ankle surgeon will select the procedure or combination of procedures best suited to the individual patient.
March is National Women’s History Month
Academy Foot and Ankle Specialists would like to highlight Rosalind Franklin.
Who is Rosalind Franklin? She certainly doesn’t have the most recognizable name…like Eleanor Roosevelt, Susan B Anthony, Anne Frank, or Mother Teresa. You probably won’t find her on any lists of famous or influential women.
In the 1950s, Franklin was instrumental in discovering the structure of the DNA double-helix molecule. The discovery of the structure of DNA was, without question, the single most important advance of modern biology.
Ms. Franklin worked intimately with 3 other scientists, Watson, Crick, and Wilkins. Franklin was a skilled X-ray crystallographer. She captured a X-ray photograph which was the basis for the understanding of the now well- known DNA alpha-helix structure. The photograph was acquired through 100 hours of X-ray exposure from a machine Dr. Franklin herself refined.
Watson, Crick, and Wilkins shared the Nobel Prize for their work in 1962. Rosalind Franklin, however, died before her work could be rewarded, in 1958 of ovarian cancer, at age 37, perhaps from radiation exposure from her work. Unfortunately, she died without ever knowing the gravity and importance of her research. She is the true definition of a pioneer!
Here are some basic foot care gudelines that everyone should follow!
- Don't ignore foot pain. It is not normal. If you experience any type of persistent pain in the foot or ankle, please contact our office.
- Inspect your feet regularly. Pay attention to changes in color and temperature. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet may indicate Athlete's Foot. Any growth on the foot is not considered normal.
- Wash your feet regularly, especially between the toes, and be sure to dry them completely.
- Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; this can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, because they are more prone to infection.
- Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.
- Select and wear the right shoe for each sport or activity that you are engaged in (e.g., running shoes for running).
- Alternate shoes—don't wear the same pair of shoes every day.
- Avoid walking barefooted. Your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet.
- Be cautious when using home remedies for foot ailments. Self-treatment may turn a minor problem into a major one.
- If you are a diabetic, please contact our office and schedule a check-up at least once a year.
Call for an appointment! 817-424-3668
Not all pain in the big toe joint or a "bump" on the big toe joint is a Bunion. It may be arthritis! Arthritis of the big toe joint is Called Hallux Limitus or Hallux Rigidus.What Is Hallux Limitus/Rigidus?
Hallux Limitus or Hallux Rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. ‘Hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and cannot move. Hallux rigidus is actually a form of degenerative arthritis. Hallux Limitus refers to the eraly forms of the arthritis and Hallux Rigidus refers to the later, more advanced stages of arthritis.
This disorder can be very troubling and even disabling, since we use the big toe whenever we walk, stoop down, climb up, or even stand. Many patients confuse hallux rigidus with a bunion, which affects the same joint, but they are very different conditions requiring different treatment.
Because hallux rigidus is a progressive condition, the toe’s motion decreases as time goes on. In its earlier stage, when motion of the big toe is only somewhat limited, the condition is called “hallux limitus.” But as the problem advances, the toe’s range of motion gradually decreases until it potentially reaches the end stage of “rigidus,” in which the big toe becomes stiff, or what is sometimes called a “frozen joint.”
Common causes of hallux rigidus are faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis – the kind that results from “wear and tear” – often develops in people who have defects that change the way their foot and big toe functions. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus.
In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that is prone to developing this condition. In other cases, it is associated with overuse – especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often have to stoop or squat. Hallux rigidus can also result from an injury, such as stubbing your toe. Or it may be caused by inflammatory diseases such as rheumatoid arthritis or gout. Your foot and ankle surgeon can determine the cause of your hallux rigidus and recommend the best treatment.
Early signs and symptoms include:
- Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
- Pain and stiffness aggravated by cold, damp weather
- Difficulty with certain activities (running, squatting)
- Swelling and inflammation around the joint
As the disorder gets more serious, additional symptoms may develop, including:
- Pain, even during rest
- Difficulty wearing shoes because bone spurs (overgrowths) develop
- Dull pain in the hip, knee, or lower back due to changes in the way you walk
- Limping (in severe cases)
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
In diagnosing hallux rigidus, the surgeon will examine your feet and move the toe to determine its range of motion. X-rays help determine how much arthritis is present as well as to evaluate any bone spurs or other abnormalities that may have formed.
In many cases, early treatment may prevent or postpone the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may include
• Shoe modifications.Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
• Orthotic devices.Custom orthotic devices may improve foot function.
• Medications.Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Injection therapy.Injections of corticosteroids may reduce inflammation and pain.
• Physical therapy.Ultrasound therapy or other physical therapy modalities may be undertaken to provide temporary relief.
When Is Surgery Needed?
In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
It’s that time of year again! After last year’s blast of ice, this year BE PREPARED!!
‘Tis the season for icy weather. And with icy weather, comes icy roads and sidewalks. If you're not careful, it could be the season for an ankle fracture! These types of fractures are very common when the conditions outside get slippery!
A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken. Twisting or rotating the ankle, rolling the ankle, tripping or falling, or direct trauma, as in a car accident, can cause these fractures.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require surgery and that you not put weight on it for a few months.
Simply put, the more bones that are broken, the more unstable the ankle becomes. There may be ligaments damaged as well. The ligaments of the ankle hold the ankle bones and joint in position.
According to the American Academy of Orthopaedic Surgeons, doctors have noticed an increase in the number and severity of broken ankles since the 1970s, due, in part, to the Baby Boomer generation being active throughout every stage of their lives.
There are a wide variety of causes for broken ankles, most commonly a fall, an automobile accident, or sports-related trauma. Because a severe sprain can often mask the symptoms of a broken ankle, every ankle injury should be examined by a physician. Symptoms of a broken ankle include:
- Immediate and severe pain.
- Inability to put any weight on the injured foot.
- Tenderness to the touch.
- Deformity, particularly if there is a dislocation or a fracture.
The treatment for a broken ankle usually involves a leg cast or brace if the fracture is stable. If the ligaments are also torn, or if the fracture created a loose fragment of bone that could irritate the joint, surgery may be required to secure the bones in place so they will heal properly.
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