Capsulitis

Capsulitis is inflammation of the capsule of a joint. The capsule is the fluid filled outer covering that joins two bones to make a joint. One of the most common capsules to get inflamed is the capsule of the metatarsophalangeal joints in the ball of the foot. There are five of these joints, joining the metatarsals to the toe bones (phalanges). The most common of these capsules to get inflamed is the capsule joining the second metatarsal to the second toe bones.

Symptoms

People that get capsulitis may report pain, swelling, redness and the sensation of walking on a stone. If it becomes a chronic situation, the individual will develop painful calluses that seem to have a core or seed in them. These are often misdiagnosed as verruca when they actually represent a biomechanical mal-alignment of the foot that results in concentrated weight bearing under a focal boney prominence, in most cases, under the second metatarsal head. These calluses can occur under any of the metatarsal heads and often respond well to orthotics with metatarsal pads and cutouts, which are an orthotic technique that allows the more prominent metatarsal head to drop, lower than its corresponding metatarsals, thus balancing the weight bearing load and decreasing the pressure. Capsulitis may be difficult to diagnose because of the other related structures in the forefoot that can also become inflamed from biomechanical problems. Sometimes people have nerve symptom associated with the swelling that occurs with capsulitis because the swollen capsule can put pressure on the adjacent nerves. There also are numerous fluid filled tissue sacs in the forefoot called bursa. When one of these bursa becomes inflamed, we call it bursitis. We generally assume the symptoms
associated with bursitis have to do with over-swelling of the fluid filled sac and inflammation of the surrounding tissues.

Possible Causes

This capsule generally gets inflamed because the forefoot is out of balance in the way that it is bearing weight, and too much pressure is placed on this joint. Shoes are the most common cause of this by the elevated toe boxes that are on most shoes. The elevation of the toe box increases the pressure under the capsules of the metatarsals. Since the second metatarsal is generally the longest in most feet, it gets more than its share of the weight bearing responsibilities and it becomes inflamed and painful. The tapering of the toe boxes of most shoes on the market also forces the big toe against the smaller second toe and out of balance with its corresponding metatarsal bone.

People with flexible or over-pronating feet often get capsulitis because the more the foot flattens and goes to the inside, the less well the first metatarsal can aid in helping the rest of the metatarsals. Unfortunately, the first metatarsal in this instance is often elevated and too flexible to be effective at bearing its share of the weight. Incidentally, the same scenario that creates the capsulitis we are discussing creates a BUNION, because in addition to the first metatarsal elevating, it also moves to the inside of the foot (adduction) more than it should.

Treatment

Rest – You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.

Ice – Place a plastic bag with ice on the front of the foot for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.

Elevate – Make sure to elevate the foot above heart level (hip level is acceptable during class).

To help prevent injury

Remember virtually all hallux limitus problems occur during the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to improve your biomechanics with orthotics designed for your chosen sport. The earlier conservative treatment of this condition takes place the less likely surgical intervention will be required.

Returning to activity

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your shin area recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg compared to the uninjured leg.
• You have full strength of the injured leg compared to the uninjured leg.
• You can jog straight ahead without pain or limping.
• You can sprint straight ahead without pain or limping.
• You can do 45-degree cuts, first at half-speed, then at full-speed.
• You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
• You can do 90-degree cuts, first at half-speed, then at full-speed.
• You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
• You can jump on both legs without pain and you can jump on the injured leg without pain.