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Saturday, August 24, 2019

Blog Contact Question #4: 2nd MPJ Capsulitis

Dear Dr Blake,

I found your podiatry blog, and was hoping to be able to ask you a question. I also tried to make an in-person appointment (I'm also in the SF area) but was told your appointment slots were booked for the next two weeks and then you're on vacation until October. I'm looking for a second opinion - I was diagnosed with 2nd mtp capsulitis in February, after a 4 mile hike where my (left) foot started hurting and by the time I got home it was very swollen and painful. Ball of the foot, felt like around under the 2nd toe but it's a bit hard to tell exactly. Was taped up and eventually put in a walking boot for 10 weeks. Got an x-ray to rule out stress fracture, which was clear. During that time, I started to get pain in around the same area on the other (right) foot, but slower onset/less severe. Was fitted with better shoes and custom orthotics (apparently have very high arches). All of these things helped, especially the boot, but the improvement post-boot was very very slow and not much improvement at all on the right side. My podiatrist is confused that it wasn't improving as quickly as he expected. 

I pushed for an MRI, last month, and the MRI report came back saying only a stress fracture of the left tibial sesamoid - but there's no pain there. Absolutely none, not even if you poke at it. (If it had said fibular, I would be less confused, that's kind of close to where the pain is on the left and almost exactly where it is on the right.) My podiatrist thinks it was just an oversensitive MRI and I should ignore it, but I want to get another opinion on:

1) is there or is there not a stress fracture (so I know if I can safely ignore it), 
2) confirm if it's actually 2nd mtp capsulitis, or sesamoiditis, or something else, and 
3) if there's anything I should be doing to speed up healing based on what you think it is.

I am happy to send along the MRI images if you'd like; I notice a mention of some WeTransfer protocol on your blog that I'm sure I can figure out. I would be happy to make a donation or whatever else for your time; your blog is truly a public service.


Dr. Blake's comment: I am so sorry I am not available for much of the next 2 months. Try the WeTransfer or drop by the office with the CD before this Thurs at 5. What is striking in your description above is that you are not using Budin Splints or taping. These are a must for 2nd MPJ capsulitis. High arch feet also have more pressure on the metatarsal heads and the orthotics may just be making this worse. The direct treatment is accommodative padding with some simple metatarsal support. You can see my partner to begin this type of treatment Dr. Jane Denton in my absence. The video below talks about the taping, but see the blog for references for budin splints. You should be icing twice a day for 5 minutes minimally, and try the new Hoka Shoe with carbon plate to see if it helps. You can also try the normal athletic Hokas. Rich


  1. Hi!!
    Love your post. It's really amazing & helpful too. I like the way you explained everything. By sharing this amazing content, you have solved my problem. Keep sharing :)
    Thank You & Regards

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  2. Hi Dr Blake, I'm a sports massage therapist and I have a client with a Lisfranc injury. He is a pro athlete
    His injury is about 6 weeks old .He is coming out of a boot.I read that you had some exercise recomendations,where can I find these please.?


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.