• 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

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

Tests and Imaging

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

Immediate Treatment

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

Possible Referral

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