In this article, you will find out everything you need to know about second toe pain and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Second Toe Pain
In this article we describe all the common causes of second toe pain and the most effective ways to treat the condition.
The second toe comprises metatarsals and the joints between them. Your ankle is attached to your second toe by the second metatarsal bone. As you know, each toe comprises three bones and two toe joints except the big third toe joint. The second toe consists of three phalanges attached to one another. The second toe and the whole of your forefoot and ball of the foot maintain your balance during standing through biomechanics.
Metatarsophalangeal (MTP) joint is present between your metatarsal bone and the proximal phalanx. A thin joint capsule is present in these joints and various ligaments support this structure.
Capsulitis of the second toe occurs due to several different factors. It may be a result of overuse and genetic factors. Athletes and active sportspeople more often experience pain in the second toe. So, early diagnosis is very important if you are experiencing any second toe capsulitis pain. There are several different treatment options to treat second toe pain. Podiatry is the branch of medicine where you study the diseases of the foot, ankle, and lower extremities.
Here, you will be learning about what second toe pain feels like and what you can do to relieve your pain if you are having it.
Table of Contents
Common Causes of Second Toe Pain
Plantar Plate Damage
There is a modified part of the joint capsule known as a plantar plate under your MTP joint. The plantar plate generally supports your joint. The second toe, also known as Morton’s toe, is usually longer than other toes. Plantar plate damage is more common in the second and third toes. Usually, you experience pain in either the upper or lower part of your toe, increasing during sports, walking, or running.
While examining the patient, the toe may be flexed or extended, with greater than normal movement. MRI and ultrasound are used for diagnosis. Flat feet and tight calf muscles increase risk.
Freiberg’s Disease
Freiberg’s disease, common in teenage girls and adults, affects the tip of your metatarsal bone (1). Reduced blood flow, trauma, high heels, or excessive sports activity contribute to its development. Early detection via MRI or X-ray is crucial to prevent bone collapse and arthritis.
Second Toe Arthritis
Rheumatoid and osteoarthritis affect the MTP joint. Persistent inflammation may lead to hammer toe deformity, a claw-like appearance of the toe.
Stress Fracture
Stress fractures affect the shaft of the bone, causing swelling, fatigue, and pain, especially during weight-bearing or high-impact activities. MRI is the most accurate diagnostic tool.
Morton’s Neuroma
Morton’s neuroma is a nerve anomaly between toes known as Morton’s neuroma. Symptoms include sharp pain, paraesthesia, and worsened pain when wearing tight shoes (2).
Metatarsalgia
Pain in the ball of your foot, often under the second toe, aggravated by tight shoes, calluses, or foot abnormalities.
Ingrown Toenail
Occurs when the toenail penetrates the skin of the second toe. Trauma, improper nail cutting, or injury can cause this (3).
Treatment
Treatment Options for Fractures
Rest, shoe inserts, splinting, or buddy taping. Surgery may be required if conservative methods fail.
Method to Treat Sprains
Rest, ice packs, elevation, compression bandages, and NSAIDs like ibuprofen (4).
Conservative Treatment of Capsulitis
Rest, ice, taping, NSAIDs, stretching exercises, supportive shoes, and orthotics. Seek podiatric advice if symptoms persist.
Treatment for Morton’s Neuroma
Arch support, wide toe box shoes, NSAIDs, local anesthetics, cortisone injections, orthotics, and activity modification. Surgery if resistant (5).
Ways to Treat Metatarsalgia
Metatarsal pad insoles, shoe modification, injections, and physical therapy.
Prolotherapy
Prolotherapy is clinically proven to treat toe pain by stimulating collagen production and repairing tissue. It targets the root cause, providing long-term relief.
Conclusion
If second toe pain occurs without trauma, a disease may be responsible. Early care prevents worsening and maintains foot and ankle function, gait, and balance.
Frequently Asked Questions
What does gout feel like in the second toe?
Swollen joint with severe pain, worsened by walking, running, or tight shoes.
What causes toe pain without injury?
Bunions, ingrown toenails, blisters, corns, calluses, arthritis, or infection.
How long does capsulitis of the second toe last?
Usually 3 months to heal completely with orthotics or cast protection.
What nerve affects the second toe?
Lateral and medial plantar digital nerves; dorsal cutaneous innervation via deep peroneal nerve.
What is Morton’s toe?
Second toe longer than the big toe, common variation called Morton’s toe.
What are the first signs of arthritis in toes?
Pain, swelling, tenderness, clicking, difficulty walking.
Case Studies
Case Study 1: Athlete with Second Toe Capsulitis
A 25-year-old runner experienced pain under the second toe. After orthotics, physical therapy, and prolotherapy, pain resolved in 6 weeks.
Case Study 2: Office Worker with Morton’s Neuroma
A 38-year-old office worker with sharp toe pain improved using wide toe box shoes, orthotics, NSAIDs, and prolotherapy within 8 weeks.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating toe pain, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with toe pain and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
LinkedIn profile: https://www.linkedin.com/in/oliver-eaton-4338225b/
References
- Binek, R., Levinsohn, E. M., Bersani, F., & Rubenstein, H. (1988). Freiberg Disease Complicating Unrelated Orthopaedics, 11(5), 753–757. https://doi.org/10.3928/0147-7447-19880501-13
- Moore, E. L., & Meredith, E. W. (1949). Morton’s toe—A neuroma. The American Journal of Surgery, 77(3), 399–401. https://doi.org/10.1016/0002-9610(49)90172-5
- Zuber, T. J., & Pfenninger, J. L. (1995). Management of ingrown toenails. American Family Physician, 52(1), 181–190. https://europepmc.org/article/med/7604762
- Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review. The American Journal of Sports Medicine, 32(1), 251–261. https://doi.org/10.1177/0363546503260757
- Thomson, L., Aujla, R. S., Divall, P., & Bhatia, M. (2019). Non-surgical treatments for Morton’s neuroma: A systematic review. Foot and Ankle Surgery. https://doi.org/10.1016/j.fas.2019.09.009