What is 2nd toe joint instability? Ligaments that surround the 2nd toe joint form a capsule with fluid inside the capsule. Instability occurs when one of the ligaments surrounding the joint become “inflamed” or torn. Instability may also be referred to as pre-dislocation syndrome where the toe joint can become dislocated or an “overlapping toe.”
What causes pre-dislocation syndrome?
What are the symptoms? Typically pain, swelling, a “marble or balled up sock sensation” below the 2nd toe joint and most obvious is an overlapping 2nd toe. The symptoms start and progressively get worse. Early diagnosis is imperative to prevent progression of the injury. The overlapping 2nd toe is the end stage of pre dislocation syndrome and plantar plate ligament rupture.
Differential Diagnosis? Accurate early diagnosis is imperative for treatment. Morton’s neuroma, stress fracture, and capsulitis are common differential diagnoses. A physical exam from a foot and ankle surgeon,
Conservative vs Surgical treatment? Conservative treatment is best in the early stages of symptoms before the 2nd toe begins to drift. Boot immobilization, NSAIDS, steroid injection, taping, and custom orthotics are all effective options. Surgery is indicated when the second toe has drifted and
Kevin C. Bryant, DPM FACFAS
Diplomat, American Board of Foot and Ankle Surgery
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