In most cases, a capsule rupture is caused by traumatic external forces. Often it is a question of rapid and powerful overstretching of the joint, which the capsule cannot withstand. The capsule can also tear in the context of a fracture near the joint. The rupture of the joint capsule can in turn lead to bone splintering close to the joint.
The cause of the capsule rupture in the toe is almost always an external force. These can be impacts and blows to the joint, but above all extreme pressure and tensile loads. On the foot, an overstretched toe is often the cause.Kicking an object with your bare foot can overstretch the joint and hit the bone at the same time.
This force must tear the strong, connective tissue structures that form the outer capsule shell. The capsule rupture can arise due to various pre-existing diseases. Long immobilization of the feet and extreme lack of exercise can lead to weakness of the connective tissue and muscles of the foot. Certain previous illnesses or genetic diseases can also lead to weak connective tissue, which can lead to capsule tears all over the body.
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The main symptom of the capsule rupture is pain. This can have a very strong and stinging character and occurs mainly when the toes are moved. Stepping on and walking are made difficult or even impossible depending on the exact location of the capsular tear. The opening of the joint capsule and the damage to smaller blood vessels result in swelling, redness and overheating a few time after the capsule rupture. The function of the joint itself is severely restricted. The redness is caused by the bruise under the skin. This is slowly reabsorbed within days to weeks, which means that the joint effusion can take on a blue, green and yellowish color. Rarely, the capsule rupture in the toe is accompanied by a fracture of the bone. This in turn can result in a significantly longer healing time, greater pain and possible misalignment of the toe.
Pain is the main symptom and the primary problem of tearing the capsule on the toe. Shortly after the injury, a throbbing, dull pain occurs on the foot, which indicates the injury to smaller blood vessels and announces the formation of a bruise. After a few days, the dull pain turns into a strong, stabbing pain with all movements in the affected joint.
The pain is primarily responsible for the functional impairment of the joint in the healing phase and can also persist over the entire healing period. The pain can and should be treated with sufficiently dosed pain medication so that easy movement is possible. Especially in the case of torn capsules on the toe, adequate pain relief should enable normal walking to prevent poor posture when walking.
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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The swelling is caused by the joint effusion that can occur in the course of the injury. The synovial fluid can spread around the joint and promote local inflammatory reactions. The injury always leads to an injury to smaller blood vessels, which can bleed into the joint capsule and are responsible for the redness, swelling and pain.
The restriction of movement is also largely due to the painful swelling. Shortly after the injury, the leg should be cooled and raised as soon as possible, as this can reduce the extent of the swelling. The entire healing time can also be greatly reduced by the acute measures and the size of the joint effusion.
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The outer shell of the joint capsule consists of ligaments, muscles and tight connective tissues that tightly enclose the joint, cushion it, move it and stabilize it. In order to achieve stability, the connective tissues are tightly anchored to the bone. If the capsule is pulled extremely hard, not only a capsule tear but also bone splintering can occur at the location of the anchoring. Involvement of the bone makes the disease even more difficult and can lead to more severe pain, longer healing times and additional instability in the joint. Treatment may also change due to bone involvement. Depending on the size of the damage to the bone, surgery may be necessary to fix the bone fragment on the toe.
You can find more about the chipping of the bone on our website Bone chipping
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The diagnosis is often only made clinically. This means that inquiries about the cause of the injury and the symptoms, as well as a physical examination, are sufficient to establish the diagnosis of a ruptured capsule. If the pain is unusually severe, the healing time is particularly long, or instabilities can be found in the physical examination, further diagnostics can be carried out to determine accompanying injuries. With the help of an X-ray, involvement of the bone in particular can be recognized and determined. An MRI can also be used to examine the extent of the capsular tear.
The MRI examination is rarely used in everyday clinical practice in the event of a capsular tear. Since the MRI examination does not usually change the treatment even if the diagnosis is confirmed, it is usually not carried out. In addition, the MRT examination is a very expensive and, compared to the X-ray examination, a complex procedure. In principle, however, a capsular tear in the toe can be shown very well in magnetic resonance imaging. Soft tissue, in particular, can be identified in high resolution, including ligaments, muscles and joint effusions. In addition, there is no radiation exposure with MRI, such as an X-ray or CT examination.
Read more on this topic at: MRI of the foot
The most important treatment steps must take place immediately after the injury. The treatment for injuries of this kind is based on the so-called "PECH scheme".
The first letters contain the words "pause", "ice," "compression" and "elevated position".
Above all, these immediate measures can stop acute bruises and thus reduce swelling, pain and restricted mobility and thus significantly reduce the healing time. These 4 treatments should be carried out within the first 48 hours.
This is followed by adequate pain therapy and rest, as well as immobilization of the toe. Particularly pronounced bruises can possibly be punctured and relieved. An operation rarely makes sense, often only if a bone is broken in addition to the capsular tear. Only after a certain time, when the swelling and pain have subsided, should slight movement in the joint be resumed in order to restore function slowly and carefully.
If a fracture of the toe is ruled out, the treatment should focus on immobilization of the toe. So-called "buddy taping" is recommended for this. An adjacent toe is used as a splint for the injured toe and glued to it. With a rigid tape bandage around both toes, the toe with the capsular tear can be immobilized and protected. It is important that the tape is changed regularly and after showering. It should also be ensured that the skin under the tape bandage is healthy and that the toe is also relieved by wearing appropriate footwear. Comfortable but also protective and stable closed shoes are suitable for this.
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A splint can also be used to immobilize the injured toe. This can be particularly useful on the big toe, as it is difficult to immobilize it completely with shoes and tapes. A splint is often not necessary for the other toes. With a bandage or tape, adequate immobilization and protection can usually be achieved.
A bandage can be used as an alternative to the splint or taping to protect the capsular tear in the toe and to immobilize the injured area. A bandage is elastic and covers the entire foot and heel. Similar to a splint, the bandage is particularly suitable for injuries to the big toe, as it protrudes prominently, is difficult to tap onto other toes and experiences increased stress when walking. In contrast to the splint, the bandage takes up less space in the shoe and is more comfortable to wear, but due to its elastic material it cannot achieve complete immobilization. The bandage is therefore unsuitable in the acute phase and the first days to weeks after the injury. It can provide additional support in the following weeks of healing, but it can also encourage slow movement.
Surgery on the toe is very rare. A pure capsule tear on the toe is usually only treated conservatively by taking care of yourself and slowly building up movement. In some cases, however, there may be a fracture in addition to the capsular tear. Slight bone fragments are also treated conservatively, whereas a complete fracture of the toe may require surgery.
An operation is necessary if there is a misalignment of the toe or instability in the foot when walking. An open fracture with injuries to the surface of the skin often requires surgery. During the operation, the fracture is returned to its natural position and stabilized with screws.
The time it takes to heal a capsule can vary greatly. The extent of the injury and the resulting swelling, pain and treatment have a significant impact on the healing time.
Slight cracks in the capsule can often heal within a few days to weeks and be painless. A complete capsule rupture with bone splintering, on the other hand, can take on a very protracted course and even cause chronic pain over time. Immobilization is often difficult to achieve, especially on the toes, so that the healing time can be delayed. Almost pain relief is achieved on average after about 2 weeks, with courses of up to 6 weeks not unusual. The healing process can also be greatly delayed by chronic processes and consequential damage.
In most cases, a capsule tear heals well and movement is usually fully restored after a few weeks. In the case of particularly severe capsule tears or incorrect treatment, long-term consequential damage and discomfort can occur.
A frequent long-term consequence of the capsular rupture in the toe is a persistent restriction of movement. This can occur if sufficient immobilization and no subsequent slow movement were achieved during the early healing phase.
Even after many years, cartilage and joint damage caused by the injury can become noticeable. Such osteoarthritis can develop over decades and lead to severe pain, restricted mobility, swelling and stiffening of the joint.
Please also read our topic on this Osteoarthritis in the big toe
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An incapacity for work can be issued for a capsule tear in the toe. This is primarily based on the patient's condition, pain and the restriction at work. In the case of severe complaints, an inability to work for 1-2 weeks is issued in most cases. In office work, the job can be practiced without restrictions in most cases despite persistent pain in the foot. This does not apply to physical activities that can be exercised over long periods of time due to the capsule rupture. The incapacity for work can also be issued beyond the 2 weeks. The family doctor can issue the certificate for up to 6 weeks without any consequences for the employee. In the case of physical activities, slow reintegration must be undertaken in rare cases if the symptoms are still too great.
