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Capsulitis of the MTP Joint

Soft Tissue Conditions· Also known as: MTP joint capsulitis, metatarsophalangeal joint capsulitisUpdated Nov 2026

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At a Glance

Capsulitis of the MTP joint is inflammation of the capsule around a joint at the base of a toe, in the ball of the foot. It is a relatively common complaint, and more so in athletes. The second toe joint is the one most often affected. The main symptom is pain on standing or walking, which many people liken to stepping on a pebble. Improvement comes gradually with care, and there is no quick fix. Left alone, it can lead to changes in how the toe sits.

What is it?

Capsulitis of the MTP joint is inflammation of the capsule around a joint at the base of a toe. The MTP joint is where a toe meets the rest of your foot, in the ball of the foot. The capsule is the covering that surrounds the joint.

Tiny, repeated injuries (micro-trauma) or damage to the capsule can make the joint produce extra fluid. The joint then swells and becomes painful when you put weight on it.

The plantar plate is a deep ligament (a strong band of tissue) that forms the underside of the capsule in each joint in the ball of the foot. Repeated small injuries can tear it.

Who does it affect?

Capsulitis is a relatively common complaint. It most often affects the second toe joint, though other toe joints can be affected too. It is seen more often in athletes. No figure is available for how many people get it.

Some people are more at risk. Carrying more body weight than average may raise the risk. With age, the fat pad (the cushion of fatty tissue under the ball of the foot) becomes thinner, which can increase pressure at the front of the foot. This thinning is more common in people with diabetes.

Signs and symptoms

The main sign is pain at the base of the affected toe, in the ball of the foot. Many people say it feels like walking on a smooth pebble or marble, or like a bunched-up sock in the shoe. The toe may feel stiff and hard to move.

The pain can be sharp, stabbing, burning or tingling, and it can spread into the toes. The area may also look swollen or red.

The pain often builds gradually over several weeks rather than coming on suddenly. It is usually worse when you stand, walk or run, and it eases with rest.

What causes it?

Capsulitis is generally thought to come partly from overuse. This means repeated pressure on the ball of the foot, from activities such as running, jumping or long walks. A sudden jump in how much you do, such as a big increase in training or time on your feet, can cause tiny injuries and inflammation.

Overload can also wear down the plantar plate, or even tear it. This can make the joint unstable.

Your foot shape and shoes matter too. Capsulitis of the second toe joint can happen alongside a bunion (a bump at the base of the big toe). As a bunion gets worse, pressure that the big toe normally takes shifts to the second toe joint. Shoes that are too narrow or have thin soles may add to the strain. Other toe changes, such as a hammer toe (a toe bent at the middle joint), may also play a part. So can inflammatory arthritis, such as rheumatoid or psoriatic arthritis.

How is it diagnosed?

Your podiatrist will ask when the pain started, what makes it worse and whether your toe has changed position. They will then examine your toe and joint with their hands. It helps to note which toe hurts, when the pain began and what brings it on. Mention any bunion, hammer toes or inflammatory arthritis too.

Plantar plate tears can cause similar pain and toe changes, and they are often missed at first. If one is suspected, a scan may be used. MRI may be more accurate than ultrasound for finding these tears, though this isn't clear yet. Ultrasound is quicker and more comfortable but can't replace MRI in every situation. If you have a pacemaker or defibrillator, tell your podiatrist before any MRI is arranged.

Other problems can feel like capsulitis, including Morton's neuroma (usually between the third and fourth metatarsals, the long bones behind the toes, with burning, tingling or numbness) and a stress fracture (early X-rays can look normal for up to three weeks). Infection and arthritis are also possible. This is why it's best not to diagnose yourself.

Treatment

Looking after it at home

Cut back on running, jumping, long walks and anything else that sets off the pain. Gentle, low-impact exercise such as swimming is a good swap. Raise and rest your foot when you can.

Ice may ease the swelling and pain. Wrap an ice pack in a towel and put it on the sore area for up to 20 minutes at a time, every two to three hours.

Wear supportive shoes with a deep, wide toe box, a lower heel, cushioned heels and good arch support. Foam or gel pads under the ball of the foot, or insoles, can cushion the joint and ease the pressure. You can buy them at a pharmacy. Stretching a stiff Achilles tendon, calf or ankle may help too. If you carry extra weight, losing some may help.

Treatment from your podiatrist

A podiatrist or physiotherapist can advise on taping the toe and a suitable stretching programme. Taping or splinting the toe may be used to steady the joint and take load off it, along with padding or offloading pads, and foot exercises to help movement and strength. Where the joint is unstable, it may be rested in a support first, with a gradual return to activity.

Other options

Steroid injections into the joint, orthoses (shoe inserts) and shoe changes are other options. In toe joint instability, they generally give only temporary relief and often don't stop the toe changing shape. How well they work for capsulitis itself isn't clear yet.

Before you agree to an injection or surgery, ask what the options are, how well each may work and what the risks are.

Surgery

Plantar plate repair is a surgical option for unstable toe joints. How well it works isn't clear yet. Decisions about injections and surgery are best made with your treating clinician.

Recovery

Recovery is gradual. There is no quick or easy fix, and your symptoms won't improve overnight. How long capsulitis takes to settle isn't clear yet.

Left untreated, capsulitis can weaken the ligaments around the joint and lead to toe dislocation (the toe slipping out of its normal position). In more advanced stages the toe can become unstable and change shape. It may drift away from its neighbour and cross over the toes beside it. Capsulitis can also progress to a hammer toe, where the toe bends at the middle joint.

If you're unsure what to do about your symptoms, see the "When to see a podiatrist" section.

Preventing it

Build up running, jumping and walking gradually rather than suddenly. Once the pain settles, keep wearing the supportive, wide-toed shoes described in Treatment. These steps are sensible habits, though it isn't clear yet whether they help prevent it coming back.

When to see a podiatrist

When to book

Book an appointment with your podiatrist if:

your pain hasn't improved after a few weeks of home care
your symptoms keep coming back
you have pain in one spot on a bone that has built up over a few weeks of running, jumping or other impact, or gets worse if you keep going
your smaller toes are becoming bent, crossed or painful
you have diabetes or poor circulation and a long-term foot problem, such as a bunion, corns or thick nails

When to get help sooner

Get urgent medical assessment (see your GP today, or go to an urgent care clinic or the nearest emergency department) if:

you have a foot wound, ulcer or infection, or a red, hot, swollen foot, and also have a fever, chills, a fast heartbeat or feel unwell
you can't put weight on your foot or take four steps after an injury
you think you may have broken a bone in your foot or ankle in an injury, for example you heard a crack, or it swelled or bruised badly within minutes

See your podiatrist or GP soon if:

you have new numbness, tingling, pins and needles or weakness in your foot that has come on gradually
your pain is getting worse, or doesn't settle with rest, less activity or pain relief

Frequently asked questions

Is capsulitis the same as metatarsalgia?

Not quite. Metatarsalgia is a general term for pain in the ball of the foot, and it has many causes. Capsulitis is one of them. Unstable toe joints, often from plantar plate injury, are another common cause. Your podiatrist can help work out which applies.

Will I need a scan?

Not always. Your podiatrist can often learn a lot from your history and a hands-on examination, including whether a plantar plate injury is likely. An MRI may be most useful when seeing whether the plantar plate looks normal or has a severe tear would affect a decision about surgery. Your podiatrist can tell you if one is worthwhile.

Can I take anti-inflammatory medicines?

Pain-relief medicines such as anti-inflammatories aren't suitable for everyone. If you're not sure whether they are right for you, check with a pharmacist or your GP before taking them. Home care steps are in the Treatment section.