Second Metatarso-phalangeal Joint Synovitis and Instability

The second metatarsophalangeal joint (see x-ray below) is located at the base of the second toe. It is a joint between the second metatarsal bone and the phalangeal bone. This joint can become inflamed, injured, and loose (or unstable). In turn, there can be pain and deformity. Synovitis is inflammation of the lining of the joint. Instability occurs when the joint becomes loose or even becomes dislocated.

Most often, pain in this joint is the result of thinning or a tear of the ligaments on the bottom of the joint. Because of the ligament problems, the joint does not track properly and becomes unstable. This results in secondary pain and inflammation.

Why do the ligaments become weak and loose? The second metatarsal bone is often the longest of the five metatarsal bones and this can result in increased pressure on its joint. Other causes include increased stress on the joint from a bunion, trauma, or rheumatoid arthritis.

Treatment involves activity modification and perhaps aspirin-like medications. Shoes with high-heels should be avoided as these increase pressure on the joint. Additionally, taping the toe or using a special splint called a Budin splint (see photo below) can help. Orthotics may reduce the pressure of walking. Steroid injections into the joint can help reduce inflammation and pain as well, although these are usually given as a last resort.

Surgery may be an option for patients with persistent pain that does not respond to non-operative measures. The operation type depends on the severity of the problem and its cause. Sometimes, the joint can stabilized. In other cases, the second metatarsal bone needs to be shortened to take pressure off of the joint. Occasionally, the second metatarsal head may need to be removed to properly realign the toe and take pressure off the joint. If there is a bunion deformity, this may need to be corrected as well.

If you are considering surgery, your doctor will speak with you further about the specifics of the planned procedure.

Long arrow pointing to second metatarso-phalangeal joint, short arrow pointing to second metatarsal bone

Long arrow pointing to second metatarso-phalangeal joint, short arrow pointing to second metatarsal bone

Budin splint

Budin splint

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