Toe Joints Injection

Acute or chronic capsulitis

Causes and findings:
• Overuse or trauma
• Hallux valgus
• Pain in toe joint
• Painful and limited: extension of the big toe, flexion of other toes

Equipment:
Syringe - 2 ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 20 mg
Lidocaine - 1 ml 2%
Total volume - 1.5 ml

Anatomy:
The first metatarsophalangeal joint line is found by palpating the space produced at the base of the metacarpal on the dorsal aspect, while passively flexing and extending the toe. Palpation of the collateral ligaments at the joint line of the other toes will identify the affected joint or joints.

Technique:
• Patient lies with foot supported
• Identify and mark joint line and distract affected toe with one hand
• Insert needle perpendicularly into joint space avoiding extensor tendons
• Deposit solution as bolus

Aftercare:
Avoidance of excessive weight-bearing activities for at least 1 week, together with taping of the joint and a toe pad between the toes. Care in choice of footwear and orthotics might be necessary.

Comments:
As with the thumb joint injection, this treatment can be very long-lasting. The other toe joints are injected from the medial or lateral aspect while under traction.