• Inflammation of the joint capsule (synovial membrane) accompanied by increased production of synovial fluid causing swelling.
  • Usually caused by overload from an associated deformity, poor foot function, inappropriate footwear (wrong size, tighter, narrower, increased heel).
  • Rheumatoid arthritis and osteoarthritis are risk factors.
  • Long-term inflammation without treatment can damage the joint capsule and result in rupture.

Diagnostic tips

  1. Pain under the central ball of the foot (directly under the joint).
  2. Inflammation around joint.
  3. Deformity of toe.
  4. Difficulty with walking.
  5. Stiffness in the joint.
  6. Neuroma-like symptoms if the nerve is irritated by the swelling.

Tests and Imaging

  1. Clinical examination and detailed history.
  2. X-ray torule out fractures or infections and evaluate extent of deformity and degree of arthritis within the joint.
  3. Bone scan can identify damage to the capsule.
  4. Ultrasound and MRI help to diagnose soft tissue problems.

Immediate Treatment

  1. Reduce activity.
  2. Advise appropriate shoes (size, fit).
  3. Advise on how to strap or splint the toes in a corrected position.
  4. Possible guided injection for inflammation and pain.

Possible Referral

  1. Refer to a podiatrist for footwear advice/modification, insoles or orthotics with deflective padding.
  2. Surgical opinion for underlying deformity.