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Second Toe Pain

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.

Common causes of second toe pain

There are several different causes of second toe pain. Some of them are given below.

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 of toe. Usually, you experience pain in either the upper or lower part of your toe. It increases when you are taking part in any sports activity or simply walking or running.

While examining the patient with plantar plate injury, the toe is seen as in flexion or extension position. Also, there will be greater movement than normal when you move your toe in any direction. To detect the damage in the plantar plate, both MRI and ultrasound are used. If you have flat feet, you are at high risk of developing plantar plate injury and foot pain due to tight calf muscles.

Freiberg’s disease

Freiberg’s disease is most common in teenage girls. The disease can also occur in adults. It is usually an uncommon condition in which the tip of your metatarsal bone is affected(1).

In this condition, the blood flow decreases in the metatarsal head. Excessive sports, trauma, or the use of high heels might be the other factors that contribute to developing Freiberg’s disease.

At first, there is swelling and pain in one part of the metatarsal bone. Due to this, the bone breaks down and ultimately collapses. Lastly, it leads to arthritis because of the flattening of the whole bone. You need to undergo MRI or x-ray to diagnose the condition. To prevent bone from collapsing, it is important to detect the condition earlier.

Second toe arthritis 

Rheumatoid arthritis and osteoarthritis also affect the MTP joint of the second toe. While walking or running, the base of toe joint takes the second toe is usually swollen and painful.

Hammer toe deformity can occur due to persistent inflammation of your second toe. It is a malalignment of the MTP joint causing the toe to take on a claw-like appearance.

Stress fracture

Stress fracture just like Frieberg’s disease can cause swelling, breakdown, and bone fatigue. The difference is that usually shaft of the bone fractures rather than the tip of the bone.

Worsening pain due to impact activity such as weight-bearing activity or jumping is usually an indicator of a stress fracture. High-impact activities put excessive pressure on your joints and feet. Mostly, MRI is done for the investigation. Ultrasound and X-ray can also detect the condition but their accuracy is not as much as needed to detect this condition.

Morton’s neuroma

In front of the foot between the toes, there is an anomaly of a specific nerve known as Morton’s neuroma (interdigital nerve). If this is your case, you will experience sharp pain in the lower part of your foot(2).

As you know, the pain occurs in the two adjacent toes because the damaged nerve innervates both of them. Loss of sensation and paraesthesia may occur. Symptoms usually get worse with wearing uncomfortable shoes or walking and running. Clinical findings help in diagnosing the problem. In addition burning pain, radiographic imaging shows the damaged nerve in the foot.

A second toe pain diagram

Metatarsalgia 

Metatarsalalgia is the pain in the ball of your foot. The pain more precisely occurs under the second toe. Typically, shoes pain is at the bottom of the foot, metatarsalgia begins as a callus or corns.

The callus will likely put pressure on nerves in fourth toes and this will develop the symptoms of metatarsalgia. Avoid using uncomfortable shoes if you already have metatarsalgia. As you know, when tight shoes rub against your toes, the friction damages the skin of your toes which ultimately aggravates the condition of metatarsalgia.

Ingrown toenail  

You suffer from an ingrown toenail when your toenail gets deeper into the skin of your third and fourth toes. It is easy to detect if you are suffering from an ingrown toenail. If the toe is sore and tender, then it is an indication of an ingrown toenail(3).

While cutting nails of the toes, any damage to the skin of the toes can become a potent cause of ingrown toenail. A direct blow or injury can also cause an ingrown toenail which if not treated in the early stages can lead to foot problems.

Treatment

Treatment options for fractures 

If you have a broken or sprained toe, you should seek a doctor. For fractures, the treatment option includes rest, shoe inserts, splinting, which is where the toe is strapped in place, and budding taping, which is where the fractured toe is taped to the toe beside it. Lastly, if all these methods do not work, your doctor may recommend you have surgery.

Method to treat sprains

As you know, a sprain is a type of injury that affects a ligament. The first step is to rest, and use an ice pack on the affected area for 20 minutes and usually 4 to 8 times a day(4). By raising the foot on a pillow, using bandages for compressing the injury, and inflammatory pain medication, such as ibuprofen to relieve pain.

Conservative treatment of capsulitis

If capsulitis lefts are untreated, it can cause the inflamed ligament to weaken. The treatment plan includes resting and applying ice, taping or splinting, and using oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). Your doctor may recommend some stretching exercises, and wearing supportive shoes with stiff soles will help too. For arch supports, use orthotic devices. If capsulitis persists, seek your doctor’s advice or go to a podiatrist for your physical exam.

Treatment for Morton’s neuroma

First of all, arch support is very necessary to combat Morton’s neuroma. By not wearing shoes, the shoes with a wide toe box, NSAIDs, local anaesthetics, or injection of cortisone. Using orthotic devices, icing the area, and stopping the activities that put pressure on the neuroma will help you to treat Morton’s neuroma(5). If resistant to other treatments, surgery is recommended.

Ways to treat metatarsalgia

Metatarsalgia may be caused by foot abnormalities, diabetes, from wearing high heels, arthritis and standing work. Usually, it is treated by metatarsal pad insoles, shoe wears modification and injections. Physical therapy is also recommended for metatarsalgia.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat toe pain.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help toe pain.

As prolotherapy is helping to treat the root cause of toe pain, it is deemed to be a permanent fix, preventing the symptoms from returning.

Conclusion

If you are having the second toe pain without any noticeable impact or an accident, a disease might be causing the pain. In this case, you should seek your doctor’s help. Second toe pain may get worse if you leave it untreated. You need to worry about yourself when the initial symptoms appear. Taking care of your lower extremities is very important as it maintains your body balance and gait. Any anomaly present in your foot or ankle will be going to affect your gait and your daily life activities.

Frequently Asked Questions

What does gout feel in the second toe?

Usually, the second toe suffering from gout feels like a swollen joint with pain that becomes severe with aggravating factors like walking or running while wearing uncomfortable shoes.

What causes toe pain without injury?

Toe pain can occur without an injury. However, the main causes of the toe pain include bunions, ingrown toenails, blisters, and corn and calluses. Arthritis and infections are some additional causes of toe pain.

How long does capsulitis of the second toe last?

It may take 3 months to completely heal from capsulitis. Orthotics or a cast may be used to protect the bone of the foot from shifting during this time.

What nerve affects the second toe?

The second toe gets innervation by lateral and medial plantar digital nerves. But via deep peroneal nerve, dorsal cutaneous innervation can be used.

What is Morton’s toe?

When the size of your second toe is larger than your big toe, it is called a royal foot or Morton‘s toe. It occurs because the first metatarsal bone is short as compared to the second metatarsal and third or fourth toes, next to it. It is completely normal to have Morton’s toe.

What are the first signs of arthritis in toes?

Pain, swelling, change in appearance, clicking and popping noises. You feel difficulty walking. Arthritis in the toe can cause tenderness, joint pain, and achiness even in the early stage.

References

  1. Binek, R., Levinsohn, E. M., Bersani, F., & Rubenstein, H. (1988). Freiberg Disease Complicating Unrelated Orthopaedicshopedics, 11(5), 753–757. https://doi.org/10.3928/0147-7447-19880501-13
  2. 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
  3. Zuber, T. J., & Pfenninger, J. L. (1995). Management of ingrown toenails. American Family Physician, 52(1), 181–190. https://europepmc.org/article/med/7604762
  4. Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American Journal of Sports Medicine, 32(1), 251–261. https://doi.org/10.1177/0363546503260757
  5. 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

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