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MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons
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Hi All,

Long story short: I've been using Newtons for the past year, PR'ed 3:29 in October at the MCM. Some small discomfort at the 2nd metatarsal, nothing too serious. Went hiking one day, pain started to get worse days after it, until could not run anymore on early Jan. Was diagnosed with MTP Synovitis (Capsulitis), which is synovitis on the joint where the metatarsal meets the 2nd toe. Dr prescribed Diclofenac, took it for 2 weeks, got a bit better, had stop it due to stomach issues. Will see Dr. on Monday to see what to do next. Haven't run for 6 weeks, still some pain when walking and when poking from the plantar face of the foot.

1) Have you had this before? at some point I thought it was Morton's neuroma, but Dr. said no. What was your treatment?
2) I want to try a different shoe once I'm cleared to run again...Which shoe would you recommend?

Thanks,
T
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [trihugger] [ In reply to ]
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Not likely a "perfect shoe" with too many variables. Have you tried a metatarsal pad in your shoes (even day-to-day ones)? Are you are an exaggerated forefoot runner? Tight calves? Long 2nd metatarsal or bunion deformity?

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [rroof] [ In reply to ]
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Thanks for your reply...

Yes, I tried the metatrarsal pad for the two weeks I was on Diclofenac... is this supposed to heal me? I don't thik it was doing much. I'm not an exagerated forefoot runner, but you mention I usually get a black toenail in that toe. Tight calves? Don't know wha that is... No long 2nd metatarsal nor bunion...can send pictures if helpful.

So...which shoe would you recommend?
tks!
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [trihugger] [ In reply to ]
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One develops capsulitis of any joint because of overuse. The metatarsal pads just tries to distribute pressure evenly and off the 2nd MTP joint. Simply not walking at all until the issue resolves would be best, but not really a feasible treatment plan.


Again, there is no best shoe, though a Newton (all models) is NOT likely a good choice for anyone with forefoot issues. Best to find a highly cushioned forefoot type shoe - an extreme example would be a Hoka shoe. Don't know if any other rearfoot pathology going on, but often people with 2nd MPJ capsulitis or plantar plate issues have high arched, somewhat rigid feet, so a more neutral type shoe is generally recommended.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [trihugger] [ In reply to ]
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Well, you can't get any better advice around here than from rroof- so listen to him before me.

What I will add: I have been dealing with this for several years- history of tight calves, midfoot striker, 2nd toe slighly longer, etc. Started with pain under the 2nd MPJ, with visible bruising. Pain eventually went away, but then was diagnosed with capsulitis and a torn plantar plate by an MSK sonographer, with 2nd metatarsal drifting under load. I suppose i will need to get that fixed at some point- spoke to a surgeon who advocated sewing up the plate via the 'Mini Scorpion' surgical device and doing an osteotomy and fixation of the 2nd metatarsal.

I have found that a shoe with a wider toe box and super soft cushioning through the forefoot and midfoot works best for me. To start, test out the Nike Lunarglide 6 or any of the Hokas. I do have some Newtons that I used to use for short runs but I have found they now worsen the issue ( for me at least, as the lugs seem to apply pressure directly on that joint).
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [rroof] [ In reply to ]
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Not trying to hijack your thread but I am wondering where exactly the metatarsal pad goes. Do you affix it to your insole, under the second toes, or the first (aka big) toe?

I have had problems with my second toes, and 2n metatarsal joint overload but my visits to a podiatrist led to more problems. At this point it feels like if I just put something like a metatarsal pad in place it would help but I'm afraid to see anyone for it after the last time
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [wickedcheezit] [ In reply to ]
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First, there are different types of met pads. You will want the domed, roughly heart shaped ones like this: http://www.amazon.com/...ords=metatarsal+pads


and not the fat L shaped ones like this: http://www.amazon.com/...ords=metatarsal+pads

The L shaped ones are often stocked at running stores around the country (i.e. Fleet Feet) and serve just to add cushioning to shoes. That is fine, but not what you are looking for with more significant 2nd MTP joint pathology. The domes ones go BEHIND the metatarsal heads, not under. Will feel odd at first, so start off with them for only an hour or so, then slowly increase. If you look at a Specialized cycling insole, they have a "metatarsal button" (their term) in all of their cycling inserts since Specialized research at the Boulder Sport Science Center revealed this to be a common problem. It isn't really very high/effective, but the idea/science is sound.

Hope this helps some.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [rroof] [ In reply to ]
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I've dealt with this, and rroof was extremely helpful. I had a slightly different pathology that required a couple of surgeries to correct (basically what tmorris described in the post above), but my symptoms were the same as you have. In the 5 years prior to surgery, I ran in Orange Superfeet with a metatarsal pad. Brooks and Adidas were my shoes of choice. I can tell you that prior to surgery the met pad allowed me to run quite a bit and mostly pain free. Post surgery - I still run in Brooks, Adidas and have added Hoka's to my rotation as well.

Once again, I would follow rroofs advice with extreme prejudice.
Last edited by: tkocanda: Feb 22, 15 6:44
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [rroof] [ In reply to ]
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Hi Rroof & all,

Thanks very much for sharing your stories, this really very helpful.

The pad the Dr. gave me was a thin piece of foam with a sling on it that goes around my 2nd toe to keep in place. I already ordered the pads that Roof recommended, thanks!

So, based on your comments, I can expect to live with it for a while until it either goes away or gets worse to require surgery, right? In the meantime, I will look into Brooks, Adidas and Hoka, as suggested by Tkocanada, thanks for the pointers on this.

Btw, I remember Dr. telling me the last time that he might try injections, something never mentioned so far on this thread. Did this help anyone?

I will circle back with my Dr. feedback, with the hope this could be helpful for someone else in the future.

Thanks,
T
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [trihugger] [ In reply to ]
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I would be very careful with injections unless you know exactly what you are dealing with (capsulitis vs. possible neuroma). Also, google crossover taping technique for plantar plate tear. That may help as well.

Good luck
Last edited by: tkocanda: Feb 22, 15 12:09
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [tkocanda] [ In reply to ]
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If you are looking for another shoe, try the Pearl Izumi N2's. Nice midfoot rocker but without the metatarsal pressure from the lugs. Love the Newtons but we have found that they are not for everyone (although I love them).

I would definately try a metatarsal pad. Properly located it could help a lot. There is a ton you can do conservatively in your shoe and with shoe choice. Is your second toe longer than your big toe?
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [joshjan] [ In reply to ]
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Thanks joshjan, I will look into the N2's. 2nd toe is smaller that big toe.
Cheers,
T
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [trihugger] [ In reply to ]
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I'm not a podiatrist or a shoe expert by any means. But, after suffering a second metatarsal fracture while running in Newtons, I switched to the Brooks Ghost. I am currently using an orange Superfeet insert with no metatarsal pad, but am considering switching to an insert with a metatarsal pad.

Seems to be a lot of injuries associated with the Newtons.
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [tkocanda] [ In reply to ]
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Tkocanada, thanks for the info. I did some digging on the crossover taping thing it but I'm not sure I found what you wanted me to find.

Update: Went to the Dr today, said that since I improved a little bit (I haven;t been running for almost 2 months already) he won't be doing the injection. Prescribed celebrex to replace voltaren (less likely to have side effects on stomach). He told me (very lightly to my disappointment) to stay off running another 3 weeks, and then to start gradually and see how it goes. A funny thing: he was very adamant in telling that the pad that will work is the one that had a sling over the 2nd toe and that other pads won't be as effective. Does anyone know the reason why? In any case, I should get the pads in a couple of days and will use it in tandem with the sling-ed one.

Thanks very much,
T
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Re: MTP Synovitis (Capsulitis) - Recommend me a shoe to replace my Newtons [tkocanda] [ In reply to ]
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I've been reading through these threads about capsulitis and metatarsalgia. Has anyone ever tried an amniotic stem cell injection to see if that would bring relief and healing? I am at wits end with all of this that started in June 2018. Wound up with a stress fracture in my 4th metatarsal and capsulitis for 4th MTP joint. The capsulitis/metatarsalgia just won't let up. I've tried different shoes, orthotics (did not feel good at all), RICE method as I was in a boot 2x and on crutches. I've done cortisone 2x in my right (1 into 3rd webspace and 1 into 4th toe joint) and it has done nothing for me. Long story short my doctors tell me they can't do much more because mri and ultrasound not showing neuroma. Ultrasound only (only is a bad word to use b/c capsulitis is a you know what!) shows capsulitis of my 3-5 MTP joints on my right side and 4-5 MTP joints in my left foot. I have a neuroma that developed in my left foot 3rd webspace as well during my right foot injury. My right is the problem foot by far. I've been trying to rehab my knee that I had scoped on 8/2/19 due to injuring it when I tried to go back to work from foot issues. My knee is doing well. my feet..mainly my right..is not. I tried to get my dr. to do an MRI w/ contrast or an arthrogram and he wouldn't do it. Any advise on stem cell injections or different imaging that should be done (ex: mri or ct w/contrast? I've done MRI, US, xrays and had a CT back in August of 2018 for my stress fracture.
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