Capsulitis and Forefoot Pain

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If you feel pain at the ball of the foot, especially around the base of the second, third or fourth toes, you may be experiencing a condition known as capsulitis. While capsulitis may start with mild symptoms, it is a problem that must be addressed early to avoid possible dislocation of the toe.

In all human joints, bones are held together by ligaments and tendons which allows for smooth movement within a normal range. These ligaments form a type of capsule where two bones are connected at a joint. If the joint is healthy, the bones are in proper alignment and function normally. When these ligaments are exposed to excessive weight-bearing pressure, become torn, worn or inflamed, capsulitis develops.

Capsulitis is painful. It is also not uncommon to experience swelling at the base of the affected toe. At other times, you may have pain while walking or while wearing certain types of shoes. Many patients report feeling a pressure sensation at the affected joint, as if walking on a marble or small pebble.

What Causes Capsulitis?

Capsulitis can develop in any joint of the body, but is most commonly seen in the foot. The big toe and small toe are generally spared, and of the remaining three toes, it is the second toe that is most commonly affected.

There are a number of reasons why an individual can develop capsulitis, ranging from genetic factors to improper use (including overuse injuries). Repeated activities that put severe pressure and stress on any of the toes of the feet could lead to inflammation of the affected toe.

Examples of such activities include sports and weight training activities, squatting/stooping while gardening, climbing ladders, working low to the ground (plumbing and electrical work), and even walking barefoot.

Another common cause is footwear selection – wearing high heel shoes without enough support causes the bending of toes at the metatarsal heads (overstretching). Ligaments at the base of the affected toe can then become inflamed.

Non-Surgical Treatment of Capsulitis

The goal of treatment is to severely reduce stress to the forefoot to a minimum and possibly redistribute the load supported by the forefoot. It is important to note that capsulitis is a progressive disorder, and will not improve without adequate treatment.

The first remedy will be to stay off the foot as much as possible. Your podiatrist may recommend additional conservative treatments like applying ice to your foot, the use of footpads, orthotics, and staying away from high heel shoes. Metatarsal pads and gel cushions are the most popular means of off-loading pressure in the forefoot.

Prescription orthotics are also useful in relieving pressure and discomfort in the forefoot. Some modifications, such as metatarsal pads, can be implemented in custom orthotics to accommodate areas affected by capsulitis.

As far as footwear is concerned, it is best to avoid the use of high heeled shoes.

Many individuals find that taping the affected toe will keep it in the proper position, prevent drifting, and relieve pain. Once the toe is allowed to drift, it will require surgery for it to be corrected.

Anti-inflammatory medicine such as ibuprofen can be used to manage pain and swelling for a short period.

A cortisone injection may also be used to reduce capsular inflammation. If you’re a candidate, you may also consider Platelet-rich Plasma injections or stem cell therapy.

Don’t wait till the pain in your feet becomes unbearable, or a simple case of capsulitis degenerates into “crossover toe,” where the affected toe becomes repositioned and lays on top of its neighbor. Dr. Gabriel Maislos, DPM, FACFAS is a recognized Houston podiatristwith over 14 years of experience treating all types of foot and ankle problems. Call (713) 541-3199 to schedule your appointment today. Houston Foot and Ankle Care accepts most major medical insurance.

Call (713) 541-3199 if you experience:

    • pain in the ball of foot, at base of toes
    • sensation as if stepping on a marble
    • second, third, or fourth toe misalignment

Houston Foot and Ankle