MTP Synovitis (Capsulitis)

What is MTP Synovitis (Capsulitis)?

MTP Synovitis (Capsulitis) Defined

MTP synovitis is an inflammation of the metatarsophalangeal (or MTP) joint synovial lining. These joints are located at the base of the toes and experience a significant amount of pressure with normal gait. MTP synovitis is associated with subsequent deformity of the affected toe, and can lead to dorsal dislocation of the toe. The 2nd MTP, the joint next to the great toe, is the most commonly affected MTP joint.

MTP Synovitis (Capsulitis) Symptoms and Anatomy

MTP synovitis is typically described as a burning or aching pain at the joint. The pain is typically made worse when walking without shoes on hard ground or flooring. The symptoms tend to be more pronounced after prolonged periods of walking and at the end of the day. The synovial lining is in close proximity to stabilizing ligaments on either side and the bottom of the joint. Consequently, as the synovitis progresses, these neighboring structures can become stretched and even begin to fail. Persons with an elongated 2nd metatarsal place additional pressure and stress on these structures, and is an important determination to make regarding your treatment.

MTP Synovitis (Capsulitis) Treatment Options

The primary goal of treatment is to provide pain relief and maintain alignment of the toe. There are toe braces called Budin splints which can be helpful at minimizing excess motion and symptoms, when worn. There are also metatarsal pad inserts which can be worn inside shoes to minimize pressure on the ball of the foot. Stiff sole shoes and sandals can also help to minimize pain at the ball of the foot. However, if shoes and inserts are ineffective, surgery may be recommended.

MTP Synovitis (Capsulitis) Surgery

Surgery is reserved for patients who have persistent pain and deformity of the toe despite non-surgical measures. If the metatarsal bone is elongated, then a bone shortening procedure can be performed to relieve the stress at the MTP joint. If there is deformity of the toe, then collateral ligaments and/or the planter ligaments may need to be repaired surgically. This typically involves an incision on top of the affected joint. After surgery, the patient can typically bear weight on the foot with a post-operative shoe or short walker boot. Please consult your orthopaedic foot and ankle surgeon if you believe you have MTP synovitis.